Login to Access Video or Poster Abstract: MP67-09
Sources of Funding: None

Introduction

After partial nephrectomy (PN), recurrent disease may develop in the remaining kidney, renal fossa, retroperitoneal lymph node, and in distant organs. The aim of the study was to analyze the characteristics of recurrence, the relevance of imaging studies in detecting recurrence, and the outcomes of surveillance after PN in a single institution. _x000D_

Methods

Retrospective study of 1060 patients who underwent PN for localized renal cell carcinoma between 2007 and 2015 at a single institution. We studied the characteristics of recurrence according to pathological and clinical features and elaborated risk groups. The type and the total numbers of imaging studies performed during surveillance or until recurrence were evaluated. Outcomes of surveillance were analyzed._x000D_ _x000D_

Results

There were 48 patients diagnosed with recurrence after median 36 months follow up. The sites of recurrence were abdominal in 62.5%, and chest in 27%. All relapses were initially detected at a single site. The recurrence was symptomatic in 10.4%. Chest x-ray and abdominal ultrasound detected 7.7% and 3.4% of all recurrences respectively. During this surveillance period, 1888 CT scans, 118 abdominal MRI, 236 abdominal US, 472 chest CT scans and 1770 chest x-rays were obtained. The number of patients to follow, and imaging studies needed in order to detect 1 recurrence were 19 and 104 respectively._x000D_ When studying the recurrence rate, and time-to-recurrence, 2 risk groups emerged. Tumors with >pT1a stage or high grade tumor or positive surgical margin status, and/or High R.E.N.A.L score had high recurrence rate with the majority of tumors recurring in the first 36 months after PN. Of the 48 patients diagnosed with recurrence, 44 (91.6%) were suitable for secondary active treatment, including 26 (54.2%) patients suitable for metastasectomy. The rate of relapse after secondary treatment was 43.5% (16.6% for the local recurrence group and 60.7% for the metastasis group). _x000D_ _x000D_ _x000D_ _x000D_ _x000D_ _x000D_

Conclusions

Patients with any adverse pathological or clinical features should be considered as high risk group and followed closely in the first 36 months with only cross-sectional studies. Chest x-ray and abdominal ultrasound have low utility in detecting recurrence and should not be considered for surveillance. Secondary active treatment is suitable for most patients with recurrence while metastasectomy fits less patients. Local recurrence is associated with increased rates of metastatic progression.

Funding

None