[Local recurrence of renal cell carcinoma after nephrectomy]

Despite significant advances in surgical oncourology, local recurrence of renal cell carcinoma (RCC) remains a serious problem both for the doctor and the patient. Our study of treatment outcomes in local recurrent RCC consisted in a retrospective analysis of 13 patients with a local RCC recurrence in the renal fossa treated with surgical resection alone between 1991 and 2003. Twelve patients demonstrated no evidence of distant metastases at the time of the recurrence. One patient had a synchronous metastasis to the contralateral adrenal gland. A mean recurrence-free interval was 14.6 months (range 2-96 months) after nephrectomy. 46% patients demonstrated symptoms of weight loss, fatigue and lumbar pains. The source of local recurrence in 2 patients was metachronous metastases to the ipsylateral adrenal gland, in 1 patients--a tumor thrombus in the remnant of the left renal vein, in 3--soft tissues of the renal fossa and in 7--metastases to the regional lymph nodes. 13 resections were performed with one intraoperative death and one immediate postoperative death. Splenectomy was made in 2 patients, resection of the stomach in 1, distal pancreatectomy in 1, resection of the inferior vena cava in 3, aorta in 1. The average blood loss was 800 ml (300-4500 ml). Up to now 6 patients survived. Of 5 decreased patients 4 died of progressive disease in 1, 4, 10 and 16 months. 1 patient died of cause unrelated to cancer recurrence in 14 months. Out of 6 alive patients 4 have no signs of the disease for, on the average, 31.6 months (range 4-78 months) and 2 patients have obvious progression of the disease (1--repeated local recurrence, 1--distant metastases) 9 and 15 months after the operation. We believe that an aggressive surgical approach to a local RCC recurrence can produce an increase in disease-free survival and significantly improve quality of life for such patients.