[Computed tomography in the follow-up of patients nephrectomized for adenocarcinoma]

A retrospective study was carried out of 159 CT examinations acquired in 64 patients who underwent unilateral nephrectomy for renal-cell carcinoma (34 in the left-hand side and 30 in the right-hand side). Thirty-nine patients were examined twice in the three years following nephrectomy; 25 were examined three or more times over a 5-year period after nephrectomy. Acute or chronic inflammatory disease was demonstrated in 6 patients (4 abscesses were detected by means of clinico-radiologic signs and 2 by means of cytology after CT-guided needle biopsy). Twenty patients had local recurrences 2-7 cm phi: in 17 of them the diagnosis was confirmed by CT-guided percutaneous FNAB; 15 patients had liver metastases, in 3 of them associated with local recurrences; 26 patients were free of both local recurrences and distant metastases. The authors analyze the value of CT in the definition of post-nephrectomy anatomic alterations, in the early detection and staging of local recurrences, and in the differentiation between postoperative fibrosis and complications. Moreover, the value is stressed of CT-guided FNAB of suspicious lesions. Our study suggests the value of a methodical CT follow-up of asymptomatic post-nephrectomy patients. CT immediately after surgery is also recommended to serve as a baseline reference for subsequent examinations. In our series, CT was accurate in the early detection of both local recurrences and distant solitary metastases.