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Renal cell carcinoma: The role of radical surgery on different patterns of local or distant recurrence
Gregorio Di Franco1, Matteo Palmeri1, Andrea Sbrana2
1General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy.
Introduction:
With the increasing reliance on targeted therapies and immunotherapy, no standard management strategy is today available for the treatment of locally, distant, or both renal cell carcinoma (RCC) recurrences, and their surgical treatment seems to play a crucial role. We report the 20-year experience of our center evaluating the short- and long-term outcomes of patients undergone surgical resection of RCC recurrences, and the possible role of repeated surgical resections of RCC recurrences.
Materials And Methods:
From January 1999 to January 2019, 40 patients underwent surgical resection of isolated locally recurrent RCC (iLR-RCC-group), locally recurrent RCC associated with the presence of distant recurrence (LR-DR-RCC-group), and distant-only recurrent RCC (DR-RCC-group). Data regarding pre-, intra-, post-operative course, and follow-up, prospectively collected in an institutional database, were retrospectively analyzed and compared.
Results:
iLR-RCC-group was composed of 9 patients, LR-DR-RCC-group of 6 patients, and DR-RCC-group of 25 patients. The recurrence rate was 55.6% (5/9 patients) in iLR-RCC-group, 50% (3/6 patients) in LR-DR-RCC-group, and 44% (11/25) patients in DR-RCC-group, p = 0.830. 3/5 (60%) patients in iLR-RCC-group, 2/3 (66.7%) patients in LR-DR-RCC-group, and 7/11 (63.6%) patients in DR-RCC group underwent to almost one further local treatments of their recurrences, respectively (p = 0.981). No differences in the mean disease-free survival (p = 0.384), overall survival (OS) (p = 0.881), and cancer-specific survival (p = 0.265) were reported between the three groups. In DR-RCC-group, patients who underwent further local treatments of new recurrences presented a longer OS: 150.7 versus 66.5 months (p = 0.004).
Conclusions:
A surgical resection of RCC recurrences should be always taken in consideration, also in metastatic patients and/or in those who have already undergone surgery of previous RCC recurrence, whenever radicality is still possible, because this approach may offer a potentially long survival.
Insights
Surgical resection of renal cell carcinoma (RCC) recurrences, even in metastatic cases, can offer potentially long survival. Repeated surgeries for RCC recurrence are feasible and may improve outcomes, particularly in distant-only recurrence groups.
Area of Science:
- Oncology
- Surgical Oncology
- Renal Cell Carcinoma Research
Background:
- No standard management exists for localized, distant, or combined renal cell carcinoma (RCC) recurrences.
- Surgical treatment plays a critical role in managing RCC recurrences.
- This study evaluates the outcomes of surgical resection for RCC recurrences over 20 years.
Purpose of the Study:
- To assess the short- and long-term outcomes of patients undergoing surgical resection of RCC recurrences.
- To investigate the role of repeated surgical resections in managing RCC recurrences.
- To compare outcomes across different recurrence patterns: isolated local, local with distant, and distant-only.
Main Methods:
- Retrospective analysis of a prospectively collected institutional database.
- Inclusion of 40 patients undergoing surgical resection for RCC recurrence from January 1999 to January 2019.
- Categorization of patients into isolated locally recurrent RCC (iLR-RCC), locally recurrent RCC with distant recurrence (LR-DR-RCC), and distant-only recurrent RCC (DR-RCC) groups.
Main Results:
- No significant differences in recurrence rates or need for further local treatments were observed between the three groups.
- Disease-free survival, overall survival (OS), and cancer-specific survival did not differ significantly across the groups.
- In the DR-RCC group, patients undergoing further local treatments for new recurrences showed a significantly longer OS (150.7 vs. 66.5 months).
Conclusions:
- Surgical resection of RCC recurrences should be considered, even in metastatic patients or those with prior surgery, if radicality is achievable.
- This approach may offer potentially long survival for patients with recurrent RCC.
- Repeated surgical interventions for RCC recurrence are a viable option, especially in cases of distant recurrence.
