Using data from the RECUR (euRopEan association of urology renal cell carcinoma guidelines panel Collaborative multicenter consortium for the studies of follow-Up and recurrence patterns in Radically treated renal cell carcinoma patients) consortium we assessed the risk of uncommon site metastasis in a cohort of 1019 patients submitted to MIS for kidney cancer matched with a cohort of 1019 patients submitted to open surgery for kidney cancer.
The two cohorts of patients with pT1-3aN0M0 renal cell carcinoma were matched for surgery, gender, clinical tumor size, year of surgery and surgical case load, to account for possible confounders. We found that patient submitted to MIS were at higher risk of local recurrence (i.e., renal recurrence in the resection bed after PN and in the renal fossa following RN) - HR 2.06; 95% CI 1.18-3.58, p-value=0.01- and of uncommon site metastasis (e.g. disseminated metastases, bone, brain, thyroid gland, skin and all the other sites not included in the previous categories, outside thoracic or abdominal cavity) - HR 1.09; 95% CI 1.01-1.16; p-value=0.04. Most of the MIS cohort patients were submitted to laparoscopic PN or RN, whereas only 70 patients to a robot-assisted approach. Of note, overall survival and cancer specific survival were similar between the two groups.
The validity of this study relies on the use of the large multi-center RECUR database with long follow-up and granular data from top European academic centers for kidney surgery. The study is hypothesis generating and more solid literature on this topic is warranted, in particular regarding robotic cases. Our findings should encourage further research on the topic to maximise surgical and oncological outcomes for our patients.
Written by: Giuseppe Fallara, MD & Umberto Capitanio, MD, Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
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