Management of local recurrence following radical nephrectomy or partial nephrectomy

Surgical excision remains the preferred form of treatment for isolated local recurrence of RCC. Involvement of contiguous organs is not uncommon for local recurrence after radical nephrectomy, and en bloc excision can be a formidable task. Local recurrence after partial nephrectomy is more likely to occur as an isolated event, and many of these patients can be salvaged with repeat partial nephrectomy or total excision of the renal remnant. Local recurrence appears to be particularly common in patients with VHL disease; repeat surgical excision has yielded encouraging results in this setting. Unfortunately, we still have little to offer patients with local recurrence associated with disseminated disease. Improved forms of systemic or adjunctive therapy will be necessary for the treatment of these patients.