In this interesting retrospective study, the authors looked at the incidence of local tumour bed recurrence after partial nephrectomy (PN), the factors associated with that, and the management. A total of 2,271 patients’ charts were reviewed who underwent partial nephrectomies over a period of 14 years between 2000 and 2014. Local tumour bed recurrence was defined as a detection of a new enhancing lesion very specifically at the surgical resection defect as well as in the same region as the partial nephrectomy site (e.g. recurrence in lower pole if PN was performed for lower pole). Patients with hereditary renal cancer were excluded. A total of 44 patients (1.9%) with local recurrence (as per above criteria) were identified (Group A). These were compared to a control group of 163 patients who were randomly selected and did not have any recurrence (Group B). Median time to local recurrence development was 23 months (2-107). Patients with local tumour bed recurrence were more likely to have a solitary kidney, bilateral disease at presentation, a higher RENAL nephrometry score, large tumours and higher clinical stage at presentation. There was no difference in operating technique or ischaemia time. However tumours in Group A had longer operative time, greater estimated blood loss, longer clamp time and more tumours excised. Patients in Group A were also more likely to have positive margins and higher pathological stage. Of the patients with recurrence, 24 (55%) underwent surgical treatment, seven (16%) were observed, radiofrequency ablation was performed in seven (16%), and systemic therapy was given in four (9%). The authors recommend further studies to assess the relationship between local recurrence as per the above criteria and local recurrence in general, and the implications on prognosis.
Local tumour bed recurrence following partial nephrectomy
Reviewed by Zeeshan Aslam
Local tumor bed recurrence following partial nephrectomy in patients with small renal masses.
CONTRIBUTOR
Zeeshan Aslam
Ninewells Hospital, Dundee, UK; Surgical Tutor, RCPS Glasgow.
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