Surgical resection of locally recurrent renal cell carcinoma after radical or partial nephrectomy: feasibility and prognostic analysis / 中华泌尿外科杂志

ABSTRACT

Objective:To evaluate the feasibility and prognostic features of surgical resection of locally recurrent renal cell carcinoma patients after initial radical or partial nephrectomy.Methods:The data of the patients treated for postoperative locally recurrent renal cell carcinoma from Jan 2005 to Dec 2019 in the Department of Urology, Peking University First Hospital, were analyzed retrospectively. Postoperative locally recurrent of renal cell carcinoma is defined as disease recurring in the remnant kidney, renal fossa, adjacent abdomen, ipsilateral adrenal or retroperitoneal lymph nodes. Secondary surgery includes radical nephrectomy, partial nephrectomy, recurrent mass resection or radiofrequency ablation. The adjuvant therapy and prognostic information after secondary surgery were obtained and analyzed. Ninety-five patients were included in the study, with the median age of 56 years old (14-82 years old). The overall median recurrent interval was 25 months (2-164 months) and the median recurrent interval for radical and partial nephrectomy patients were 30 months and 25 months, with no significant difference. As for the secondary surgery, 63 patients underwent open surgery, 22 patients with laparoscopic surgery and 10 patients with radiofrequency ablation therapy.Result:The median operation time of secondary surgery was 148 minutes (35-330 minutes) and median intraoperative blood loss of 150 ml (20-3 000 ml). There were 8 cases of stage Ⅰ or stage Ⅱ postoperative complication, including wound infection and anemia. A stage Ⅲ complication of postoperative hematuria occured. The patient underwent renal artery embolization to control the hematuria. Eight patients suffered local recurrence and 10 patients experienced distant metastasis after the secondary surgery. During the follow-up, 6 patients died. The overall 3-year, 5-year disease free survival rate was 85.8% and 53.3%, respectively. The median survival time of patients with remnant kidney, renal fossa, and adjacent abdomen recurrence was 78 months, while 49 months for patients with ipsilateral adrenal and retroperitoneal lymph nodes recurrence ( P=0.141). Conclusions:With sufficient evaluation and preparation, the resection of the recurrent mass could be feasible and safe. With completion resection and negative surgery margin, patients could obtain relative long-term survival.