OBJECTIVES: There is lack of consensus in the Urology community regarding surveillance after laparoscopic partial nephrectomy particularly for patients with stage I tumors.
The purpose of this paper is to characterize the rate of recurrence after partial nephrectomy in a low risk cohort.
METHODS: Data were collected on all laparoscopic partial nephrectomies performed at a single institution from January 2006 through May 2011. Patients without at least 1 year of follow-up information were excluded from examination. Patients were stratified based on pathologic tumor stage at the time of partial nephrectomy. Patients with stage I (a and b) tumors were then examined for recurrence.
RESULTS: A total of 639 patients underwent laparoscopic partial nephrectomy during the time period. Of this, 360 patients had stage T1 RCC (302 with pT1a and 58 with pT1b) and met research criteria. There were 8 recurrences (2.2%) within this cohort (Table 1). All of the tumors were of clear cell histology and none had Furhman grade 1 histology. Only 1 of these patients had a positive margin at the time of partial nephrectomy and all patients had negative biopsy of the tumor resection bed. A majority of the recurrences occurred locally in the ipsilateral kidney or retroperitoneum. Most of the recurrences occurred within 1-2 years post-operatively.
CONCLUSIONS: Approximately 2% of patients who underwent laparoscopic partial nephrectomy for renal cell carcinoma with resultant low risk, stage I tumor pathology developed metastasis. There were no recurrences in non-clear cell pathologies and no recurrences with Furhman grade 1 or tumors smaller than 3cm.
Written by:
Kreshover JE, Richstone L, Kavoussi LR. Are you the author?
North Shore - Long Island Jewish Medical Center, Arthur Smith Institute of Urology, New Hyde Park, New York, United States.
Reference: J Endourol. 2013 Sep 2. Epub ahead of print.
doi: 10.1089/end.2013-0197.ECC13
PubMed Abstract
PMID: 23998639
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