Management of Locally Recurrent Kidney Cancer
- 94 Downloads
Locally recurrent kidney cancer is an uncommon but complicated problem. Due to the recognition of the importance of renal preservation and an increase in the use of nephron-sparing approaches via surgery or ablation, locally recurrent disease is being encountered with greater frequency. Treatments for locally recurrent kidney cancer include radical nephrectomy, repeat or salvage partial nephrectomy, de novo or repeat ablation, observation, or experimental systemic therapy. Each of these options has its own constellation of risks and benefits. When local recurrence is detected, the majority of renal units may be saved, but this often comes at the expense of higher perioperative complication rates, which rise with the number of previous interventions on the ipsilateral kidney. Extensive preoperative patient counseling is required to properly individualize therapy. Referral to a center of excellence should be considered before attempting repeat or salvage renal surgery.
KeywordsKidney cancer Recurrent kidney cancer Multifocal kidney cancer Partial nephrectomy Repeat renal surgery Salvage partial nephrectomy Ablation
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.•• Campbell SC, Novick AC, Belldegrun A, et al.: Guideline for management of the clinical T1 renal mass. J Urol 2009, 182:1271–1279. The American Urological Association guidelines for the treatment of renal masses less than 7 cm address resection, ablation, and observation.Google Scholar
- 7.Nadler RB, Loeb S, Clemens JQ, et al.: A prospective study of laparoscopic radical nephrectomy for T1 tumors: is transperitoneal, retroperitoneal or hand assisted the best approach? J Urol 2006, 175:1230–1233; discussion 1234.Google Scholar
- 19.Thompson RH, Boorjian SA, Lohse CM, et al.: Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy. J Urol 2008, 179:468–471; discussion 472–473.Google Scholar
- 24.• Kunkle DA, Egleston BL, Uzzo RG: Excise, ablate or observe: the small renal mass dilemma–a meta-analysis and review. J Urol 2008, 179:1227–1233; discussion 1233–1234. This excellent review discusses the treatment modalities available for small renal masses.Google Scholar
- 25.• Rini BI: Metastatic renal cell carcinoma: many treatment options, one patient. J Clin Oncol 2009, 27:3225–3234. This is an excellent review of systemic therapy for metastatic RCC.Google Scholar
- 26.Whang M, O’Toole K, Bixon R, et al.: The incidence of multifocal renal cell carcinoma in patients who are candidates for partial nephrectomy. J Urol 1995, 154:968–970; discussion 970–971.Google Scholar
- 27.• Sudarshan S, Linehan WM: Genetic basis of cancer of the kidney. Semin Oncol 2006, 33:544–551. This is a concise primer on hereditary forms of kidney cancer.Google Scholar
- 31.Johnson A, Sudarshan S, Liu J, et al.: Feasibility and outcomes of repeat partial nephrectomy. J Urol 2008, 180:89–93; discussion 93.Google Scholar
- 35.United States Renal Data System: Annual data report 2009. Available at http://www.usrds.org/adr.htm. Accessed October 2009.
- 36.Liu N, Khurana K, Sundarshan S, et al.: Surgical, functional, and oncologic outcomes of repeat partial nephrectomy on a solitary kidney. Presented at the 9th Annual Meeting of the Society of Urologic Oncology. Bethesda, MD; December 4–5, 2008.Google Scholar
- 38.Nguyen CT, Lane BR, Kaouk JH, et al.: Surgical salvage of renal cell carcinoma recurrence after thermal ablative therapy. J Urol 2008, 180:104–109; discussion 109.Google Scholar
- 42.• Kutikov A, Uzzo RG: The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 2009, 182:844–853. This article discusses a novel metric for measuring the anatomic complexity of a renal mass.Google Scholar
- 44.National Cancer Institute: National Cancer Institute search for clinical trials. Available at http://www.cancer.gov/clinicaltrials/search/. Accessed October 2009.
- 48.Fergany AF, Saad IR, Woo L, Novick AC: Open partial nephrectomy for tumor in a solitary kidney: experience with 400 cases. J Urol 2006, 175:1630–1633; discussion 1633.Google Scholar
- 49.Jacobsohn KM, Ahrar K, Wood CG, Matin SF: Is radiofrequency ablation safe for solitary kidneys? Urology 2007, 69:819–823; discussion 823.Google Scholar
- 50.Lane BR, Novick AC, Babineau D, et al.: Comparison of laparoscopic and open partial nephrectomy for tumor in a solitary kidney. J Urol 2008, 179:847–851; discussion 852.Google Scholar