Local-Regional Recurrence of Renal Cell Carcinoma following Nephrectomy. Our Experience

Abstract

Introduction

Locally recurrent renal cell carcinoma (RCC) after nephrectomy is uncommon (1.3% of our cases) and prognosis is poor. There is as yet no standard treatment, but radical surgery is classed by many authors as the best therapeutic approach given the relative ineffectiveness of chemo-immunotherapy and radiotherapy. The surgical approach and follow-up protocol that we adopt are described.

Materials and methods

Between January 1985 and December 1996, 7 patients (2 M - 5 F; mean age 63 - range 47–72), nephrectomised for RCC, underwent further surgery of the homolateral renal cavity. The stage of the primary neoplasm was pT3G3N0 in 3 patients, pT3G2N0 in 2, pT3G1N0 in 1 and pT2G2N0 in 1. Recurrence appeared on average at 30 months (12–84), with a diameter varying between 14 to 40 mm. Patients were staged again by median laparotomic access; no remote metastases were found. Three patients received adjuvant therapy with biological response modulators.

Results

Histological results confirmed recurrence of the primitive tumour in all cases and metastatised lymph node tissue was found in just one case. Four patients were still alive (2 disease-free, 2 with lung and multi-organ metastases respectively) after a mean follow-up of 24 months (15–54) following removal of the local recurrence. Two patients died at 13 and 27 months after surgery due to progression of the disease, whilst 1 patient died from uncorrelated pathology after 30 months. Of the above 4 live patients, 3 developed a single metastasis at 5, 8 and 21 months after treatment of the first local recurrence and underwent further radical surgery (2 in the pelvic pouch, 1 vaginal). They also received adjuvant therapy with biological response modulators after the 2nd operation. The disease progressed, however, and only 1 patient is alive with multiple metastasis.

Conclusions

Surgery of local recurrences of RCC presents no particular difficulties, whilst allowing excellent control of the neoplasm and survival free from advancing diseases. The role that adiuvant therapy (immunomodulators) plays is not yet certain, but could be associated with surgical removal, considering the possible co-existence of micrometastases that cannot clinically be shown.