Local recurrence:
Defined in the EAU guidelines as local recurrence in the ipsilateral kidney, within the renal fossa, the renal vein, the ipsilateral adrenal gland or in regional lymph nodes.
After nephrectomy is very rare – 1 – 3 %.
- Resection should be considered – can achieve long term disease free survival.
- High risk of morbidity – no normal tissue planes exist
- Isolated local recurrence does affect survival
Still rare after partial nephrectomy – ~3 % ( 1 – 10 %)
- Can be managed with repeat partial nephrectomy, nephrectomy, ablation or surveillance
- Surveillance often appropriate
- Often will have recurrences away from the site of initial resection (?metastatic vs multifocal)
- Not uncommon to have T0 nephrectomy following a partial nephrectomy with alleged positive margin
Up to 15 % following thermal ablation.
- Can be managed often with repeat ablation. Surgery can be challenging.
The majority of patients with local recurrence will also have or will develop metastatic disease.
EAU guidelines:
Optimal treatment for local recurrence is not yet defined
Offer local treatment of local recurrence when technically possible, and after balancing adverse prognostic features, co-morbidities and life expectancy.
Metastatic recurrence:
The best prognosis is solitary lung recurrence, which can be resected.
Often metastatic disease is very slow growing and can be observed rather than treated immediately.
Retrospective comparative studies consistently point towards benefit of complete metastasectomy in metastatic RCC in terms of overall survival, cancer specific survival, and delay of systemic treatment.
Metastasectomy, whilst not supported by prospective data, is a reasonable and widely used practice in appropriately selected patients.
Improved survival outcomes are likely to be partly explained by patient selection.
Bone and brain metastases can often be treated with radiation for effective symptom control.