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Rezidivtumor beim Nierenkarzinom

Das „Lokalrezidiv“ nach nierenerhaltender oder radikaler Resektion

Recurrent disease in renal cell carcinoma

Locally recurrent tumors after nephron-sparing and radical procedures

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Zusammenfassung

Der Begriff des „Lokalrezidivs“ beim Nierenkarzinom hat sich gewandelt. Hierunter fallen angesichts eines breiten Spektrums moderner Behandlungsverfahren sowohl das traditionelle, ipsilateral im Retroperitoneum gelegene Tumorrezidiv nach Nephrektomie, als auch die renalen und extrarenalen Rezidive nach einer nierenerhaltenden Operation oder nach einer minimal-invasiven, alternativen Tumorablation.

Die vorliegende Übersicht analysiert Häufigkeiten, Risikofaktoren, prädisponierende Operationstechniken und Interventionsverfahren in Bezug auf das Auftreten von renal lokalisierten Rezidiven, isolierten Lokalrezidiven in der Fossa lumbalis und Lokalrezidiven mit einer synchronen Metastasierung.

Die onkologischen Verlaufsdaten und prognostischen Erfolgsraten von verschiedenen Therapiestrategien werden vergleichend bewertet, und deuten bei einem isoliert-lokalen Rezidiv einheitlich auf das Primat einer operativen Sanierung. Eine statistisch abgesicherte Standardtherapie existiert allerdings für keine Behandlungssituation.

Abstract

Locally recurrent renal cell carcinoma (RCC) is 0–10% after nephron-sparing surgery, 2.5–4% after thermoablative interventions and 2–3% after (radical) nephrectomy. Risk-factors are: sporadic or hereditary origin, tumor size, multifocality, histologic phenotype and incomplete resection.

To date, there are no significant differences in the incidence of locally recurrent tumors independently of whether open or laparoscopic techniques were preferred. Caution still has to be taken with the use of alternative tools for minimally invasive tumor ablation.

Finally, no statistically proven standard therapy exists that would clearly provide a superior outcome for patients with an isolated local recurrence. However, meta-analyses strongly support the performance of a resection of the recurrence as the primary working principal.

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Literatur

  1. Alter AJ, Uehling DT, Zwiebel WJ (1979) Computed tomography of the retroperitoneum following nephrectomy. Radiology 133: 663–668

    Google Scholar 

  2. Bassil, Dosoretz De, Prout GR (1985) Validation of the tumor, nodes and metastasis classification of renal cell carcinoma. J Urol 134: 450–454

    Google Scholar 

  3. Bloom DA, Kaufman JJ, Smith RB (1981) Late recurrence of renal tubular carcinoma. J Urol 126: 546–548

    Google Scholar 

  4. Blute ML, Leibovich BC, Cheville JC, Lohse CM, Zincke H (2004) A protocol for extended lymph node dissection using primary tumor pathologic features for patients treated with radical nephrectomy for clear cell renal cell carcinoma. J Urol 171 [Suppl 4]: 467 (abstract 1766)

  5. Campbell SC, Novick AC (1994) Management of local recurrence following radical nephrectomy or partial nephrectomy. Urol Clin N Amer 21: 593–599

    Google Scholar 

  6. Castilho LN, Fugita OE, Mitre AI, Arap S (2001) Port site tumor recurrences of renal cell carcinoma after vidolaparoscopic radical nephrectomy. J Urol 165: 519

    Google Scholar 

  7. Castilla EA, Liour LS, Abrahams NA, Fergany A, Rybicki Lak, Myles J, Novick AC (2002) Prognostic importance of resection margin width after nephron-sparing surgery for renal cell carcinoma. Urology 60: 993–997

    Google Scholar 

  8. Cerfolio RJ, Allen MS, Deschamps C, Daly RC, Wallrichs SL, Trastek VF, Pairolero PC (1994) Pulmonary resection of metastatic renal cell carcinoma. Ann Thorac Surg 57: 339–344

    CAS  PubMed  Google Scholar 

  9. de Kernion JB, Ramming KP, Smith RB (1978) The natural history of metastatic renal cell carcinoma: a computer analysis. J Urol 120: 148–152

    CAS  PubMed  Google Scholar 

  10. del Carmen MG, Eisner B, Willer CG, Fuller AF (2003) Intraoperative radiation therapy in the management of gynecologic and genitourinary malignancies. Surg Oncol Clin N Am 12: 1031–1042

    Google Scholar 

  11. DiMarco DS, Lohse CM, Zincke H, Cheville JC, Blute ML (2004) Long-term survival of patients with unilateral sporadic multifocal renal celll carcinoma according to histologic subtype compared with patients with solitary tumors after radical nephrctomy. Urology 64: 462–467

    Google Scholar 

  12. Eble MJ, Staehler G, Wannenmacher M (1997) IORT for locally advanced or recurrent renal cell carcinoma. Front Radiat Ther Oncol 31: 253–255

    Google Scholar 

  13. Esrig D, Ahlering TE, Lieskovsky G, Skinner DG (1992) Experience with fossa recurrence of renal cell carcinoma. J Urol 147: 1491–1494

    Google Scholar 

  14. Fentie DD, Barrett PH, Taranger LA (2000) Metastatic renal cell cancer after laparoscopic radical nephrectomy: long-term follow-up. J Endourol 14: 407–411

    Google Scholar 

  15. Finney R (1973) The value of radiotherapy in the treatment of hypernephroma—a clinical trial. Br J Urol 45: 258–269

    Google Scholar 

  16. Frydenberg M, Gunderson I, Hahn G, Fieck J, Zincke H (1994) Preoperative external beam radiotherapy followed by cytoreductive surgery and intraoperative radiotherapy for locally advanced primary or recurrent renal malignancies. J Urol 152: 15–21

    Google Scholar 

  17. Gervais DA, McGovern FJ, Arellano RS, McDougal WS, Müeller PR (2003) Renal cell carcinoma: clinical experience and technical success with radio-frequency ablation of 42 tumors. Radiology 226: 417–424

    PubMed  Google Scholar 

  18. Ghavamian R, Cheville JC, Lolhse CM, Weaver AL, Zincke H, Blute ML (2002) Renal cell carcinoma in the solitary kidney: an analysis of complications and outcome after nephron sparing surgery. J Urol 168: 454–459

    Google Scholar 

  19. Gill IS, Merany AM, Schweizer DK et al. (2001) Laparoscopic radical nephrectomy in 100 patients : a single center experience from the United States. Cancer 92: 1843–1855

    Google Scholar 

  20. Gill IS (2003) Minimally invasive nephron-sparing surgery. Urol Clin N Am 30: 551–579

    Google Scholar 

  21. Giuliani L, Giberti C, Martorana G, Rovida S (1990) radical extensive surgery for renal cell carcinoma: long-term results and prognostic factors. J Urol 143: 468–473

    Google Scholar 

  22. Gogus C, Baltaci S, Beduk Y, Sahinli S, Kupeli S, Gogus O (2003) Isolated local recurrence of renal cell carcinoma after radical nephrectomy: experience with 10 cases. Urology 61: 926–929

    Google Scholar 

  23. Hafez KS, Novick AC, Campbell SC (1997) Patterns of tumour recurrence and guidelines for follow up after nephron sparing surgery for sporadic renal cell carcinoma. J Urol 157: 2067–2070

    Google Scholar 

  24. Harmon JD, Parulkar BG, Doble A, Rujstalis DB (2004) Critical assassment of cancer recurrence following renal cryoablation: a multi-center review. J Urol 171 [Suppl 4]: 469 (abstract 1775)

  25. Hayakawa K, Aoyagi T, Ohashi M, Hata M (2004) Comparison of gas-less laparoscopy-assisted surgery, hand-assisted laparoscopic surgery and pure laparoscopic surgery for radical nephrectomy. Int J Urol 11: 142–147

    Google Scholar 

  26. Itano NB, Blute ML, Spotts B, Zincke H (2000) Outcome of isolated renal cell carcinoma fossa recurrence after nephrectomy. J Urol 164: 322–325

    Google Scholar 

  27. Iwamura M, Tsumura H, Matsuda D, Kurosaka S, Yoshida K, Baba S (2004) Port site recurrence of renal cell carcinoma following retroperitoneoscopic radical nephrectomy with manual extraction without using entrapment sac or wound protector. J Urol 171: 1234–1235

    Google Scholar 

  28. Jacobs SC, Berg SI and Lawson RK (1980) Synchronous bilateral renal cell carcinoma: total surgery excision. Cancer 46: 2341–2345

    Google Scholar 

  29. Janzen NK, Kim HL, Figlin RA, Belldegrun AS (2003) Surveillance after radical or partial nephrectomy for localized renal cell carcinoma and management of recurrent disease. Urol Clin North Am 30: 843–852

    Google Scholar 

  30. Kavolius JP, Mastorakos DP, Pavlovich C, Russo P, Burt ME, Brady MS (1998) Resection of metastatic renal cell carcinoma. J Clin Oncol 16: 2261–2266

    CAS  PubMed  Google Scholar 

  31. Kobayashi M, Hashimoto S, Tokue A (2000) Nephron-sparing surgery is still controversial for patients with renal cell carcinoma and normal contralateral kidney: risks predictable by AgNOR counts in satellite lesions. Mol Urol 4: 21

    Google Scholar 

  32. Krejci KG, Blute ML, Cheville JC, Sebo TJ, Lohse CM, Zincke H (2003) Nephron-sparing surgery for renal cell carcinoma: clinicopathologic features predictive of patient outcome. Urology 62: 641–646

    Google Scholar 

  33. Lang H, Lindner V, Martin M, Letourneux H, Roy C, Saussine C, Jacqumin D (2004) Prognostic value of multifocality on progression and survival in localized renal cell carcinoma. Eur Urol 45: 749–753

    Google Scholar 

  34. Lee DI, McGinnis DE, Feld R, Strup SE (2003) Retroperitoneal laparoscopic cryoablation of small renal tumors: intermediate results. Urology 61: 83–88

    Google Scholar 

  35. Leibovich BC, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H (2004) Nephron sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm results in outcome similar to radical nephrectomy. J Urol 171: 1066–1070

    Google Scholar 

  36. Lund GO, Fallon B, Curtis MA, Williams RD (1994) Conservative surgical therapy of localized renal cell carcinoma in Hippel-Lindau disease. Cancer 74: 2541–2545

    Google Scholar 

  37. Mahnken AH, Rohde D, Brkovic D, Günther RW, Tacke MD (2005) Percutaneous radiofrequency ablation of renal cell carcinoma: preliminary results. Acta Radiol 46: (in press)

  38. Manikandan R, Srinivasan V, Rane A (2004) Which is the real gold standard for small-volume renal tumors? Radical nephrectomy versus nephron-sparing surgery. J Endourol 18: 39–44

    Google Scholar 

  39. Matlage BR, Zagoria RJ, Woodruff RD, Torti FM, Hall MC (2002) Phase II trial of radifrequency ablation of renal cancer: evaluation of the kill zone. J Urol 168: 2401–2405

    PubMed  Google Scholar 

  40. McNichols DW, Segura JW, DeWeerd JH (1981) Renal cell carcinoma: long-term survival and late recurrence. J Urol 126: 17–23

    Google Scholar 

  41. Michaels MJ, Rhee HK, Mourtzinos AP, Summerhayes IC, Silverman ML, Libertino JA (2002) Incomplete renal tumor destruction using radio frequency interstitial ablation. J Urol 168: 2406–2410

    PubMed  Google Scholar 

  42. Moll V, Becht E, Ziegler M (1993) Kidney preserving surgery in renal cell tumors: indications technics and results in 152 patients. J Urol 150: 319–323

    Google Scholar 

  43. Nickolisen R, Fallon B (1985) Locally recurrent hypernephroma treated by radiation therapy and embolization. Cancer 56: 1049–1051

    Google Scholar 

  44. Nieder AM, Taneja SS (2003) The role of nephrectomy for renal cell carcinoma in comtemporary practice. Urol Clin N Am 30: 529–542

    Google Scholar 

  45. Ogan K, Cadeddu JA, Stifelman MD (2003) Laparoscopic radical nephrectomy: oncologic efficacy. Urol Clin N Am 30: 543–550

    Google Scholar 

  46. Ono Y, Kinukawa T, Hattori R, Gothoh M, Kamihira O, Ohshima S (2003) The long-term outcome of laparoscopic radical nephrectomy for small renal cell carcinoma. J Urol 165: 1867–1870

    Google Scholar 

  47. Parienty RA, Richard F, Pradel J, Vallancien G (1984) Local recurrence after nephrectomy for primary renal cancer: computed tomography recognition. J Urol 132: 246–250

    Google Scholar 

  48. Pereverzev AS, Shchukin DV, Iliukhin IuA (2003) Local recurrence of renal cell carcinoma after nephrectomy. Urologiia 6: 14–18

    Google Scholar 

  49. Phillips E, Messing EM (1993) Role of lymphadenectomy in the treatment of renal cell carcinoma. Urology 41: 9-15

    Google Scholar 

  50. Popken G, Wetterauer U, Schultze-Seemann W (1999) Kidney-preserving tumour resection in renal cell carcinoma with photodynamic detection by 5-aminolaevulinic aced: preclinical and preliminary clinical results. BJU Int 83: 578–582

    Google Scholar 

  51. Rafla S (1970) Renal cell carcinoma: Natural history and results on treatment. Cancer 25: 26–40

    Google Scholar 

  52. Raj GF, Reddan DJ, Hoey MB, Polascik TJ (2003) Management of small renal tumors with radiofrequency ablation. Urology 61: 23–29

    Article  Google Scholar 

  53. Rassweiler JJ, Paz A, Gaitonde KD, Seemann O, Frede T (2002) Laparoscopic surgery for urologic malignancies: the risk of local recurrence and port site metastasis. J Urol 167: 84

    PubMed  Google Scholar 

  54. Reddan DN, Raj GV, Polascik TJ (2001) Management of small renal tumors: an overview. Am J Med 110: 558–562

    Article  CAS  PubMed  Google Scholar 

  55. Rendon RA, Kachura JR, Sweet M et al. (2002) The uncertainity of radiofequency treatment of renal cell carcinoma: findings at immediate and delayed nephrectomy. J Urol 167: 1578–1592

    Google Scholar 

  56. Rohde D, Albers C, Mahnken A, Tacke J (2003) Regional thermoablation of local or metastatic renal cell carcinoma (RCC). Oncol Rep 10: 753–757

    Google Scholar 

  57. Schlichter A, Wunderlich H, Junker K, Kosmehl H, Zermann DH, Schubert J (2000) Where are the limits of elective nephron-sparing surgery in renal cell carcinoma? Eur Urol 37: 517–520

    Google Scholar 

  58. Schrödter S, Hakenberg OW, Manseck A, Leike S, Wirth MP (2002) Outcome of surgical treatment of isolated local recurrence after radical nephrectomy for renal cell carcinoma. J Urol 167: 1630–1633

    Google Scholar 

  59. Sease WC, Belis JA (1986) Computerized tomography in the early postoperative management of renal cell carcinoma. J Urol 136: 792–794

    Google Scholar 

  60. Skinner DG, Colvin RB, Vermillion CD, Pfister RC, Leadbetter WF (1971) Diagnosis and management of renal cell carcinoma. Clinical and pathologic study of 309 cases. Cancer 28: 1165–1167

    Google Scholar 

  61. Stephenson AJ, Chetner MP, Rourke K et al. (2004) Guidelines for the surveillance of localized renal cell carcinoma based on the patterns of relapse after nephrectomy. J Urol 172: 58–62

    Google Scholar 

  62. Tacke J, Mahnken AH (2004) Perkutane Radiofequenzablation von Nierentumoren. Radiologe 44: 358–363

    Google Scholar 

  63. Tanguay S, Pisters LL, Lawrence DD, Dinney CPN (1996) Therapy of locally recurrent renal cell carcinoma after nephrectomy. J Urol 155: 26–29

    Google Scholar 

  64. Uson AC (1982) Tumor recurrence in the renal fossa and/or the abdominal wall after radical nephrectomy for renal cell carcinoma. Prog Clin Biol Res 100: 549–560

    Google Scholar 

  65. Van Poppel H, Bamelis B, Oyen R, Baert L (1998) Partial nephrectomy for renal cell carcinoma can achieve long-term tumor control. J Urol 160: 674–678

    Google Scholar 

  66. Wiesner C, Jakse G, Rohde D (2002) Therapy of local recurrence of renal cell carcinoma. Oncol Rep 9 (1): 189–192

    Google Scholar 

  67. Wunderlich H, Reichelt O, Schumann S et al. (1998) Nephron sparing surgery for renal cell carcinoma 4 cm or less in diameter: indicated or under treated. J Urol 159: 1465–1469

    Google Scholar 

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  1. Urologische Klinik, Klinikum Darmstadt

    M. Löhr &  D. Rohde

  2. Urologische Klinik, Klinikum Darmstadt, Grafenstraße 9, 64283, Darmstadt

    D. Rohde

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Löhr, M., Rohde, D. Rezidivtumor beim Nierenkarzinom. Urologe [A] 44, 358–368 (2005). https://doi.org/10.1007/s00120-005-0785-9

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