Introduction

Local recurrence (LR) without distant metastases after renal cancer (RC) treatment is relatively rare. In this context, little is known regarding the natural history after salvage surgery for LR.

Methods

We conducted a retrospective analysis on a cohort of 62 consecutive patients presenting with local recurrence after primary surgical treatment for RC at two academic institutions. In 25 cases (40.3%), patients presenting concomitant visceral and/or bone metastases were excluded. LR was defined as the presence of a pathologically confirmed recurrence of RC in the soft/tissue renal fossa after radical (RN) or at the level of the resection bed after partial nephrectomy (PN), respectively. All patients were treated with the complete surgical resection of the LR. Kaplan-Meier analysis was applied to assess rates of systemic progression (SP; defined as the evidence of distant metastases during the follow-up), disease-free survival (DFS; defined as the absence of either distant or local recurrence) and cancer specific mortality (CSM) after surgical resection of LR

Results

Overall, 37 patients had exclusive LR (59.6%). Of those, 21 (55.6%) vs. 16 (44.4%) patients were diagnosed with an LR after RN vs. PN, respectively. Median [mean (Q1-Q3)] time to LR was 18 [29.9 (8-42)] months after RN/PN. At initial treatment (PN or RN), pathologic T stage (pT) was pT1, pT2, pT3 and pT4 in 14 (38.2%) 8 (18.9%), 14 (38.2%) and 1 (2.9%) patients. Fuhrman grade resulted low (1-2) vs. high (3-4) in 21 (59.4%) vs. 16 (40.7%) patients._x000D_ At LR diagnosis, 28 (75.7%) patients were treated with LR resection only, while 9 (24.3%) received also systemic targeted therapy after LR resection. At 1 and 3 years after LR surgery, SP rates were 20% and 45% vs. 7% and 23% in RN vs. PN cases, respectively. Overall, at 1, 3 and 5 years after LR surgery, DFS was 93%, 85% and 67%. CSM resulted 10%, 20% and 25%, respectively. There was no significant difference in terms of SP, DFS and CSM between patients surgically treated for LR after RN or PN (all p>0.05).

Conclusions

Despite a surgical treatment of LR after either PN or RN, a systemic progression can be expected. However, given the encouraging results in terms of DFS and CSM, such management could be justified in clinical practice.

Funding

none