The blind spots in follow-up after nephrectomy or nephron-sparing surgery for localized renal cell carcinoma

• Published in: World journal of urology 2015-06, Vol.33 (6), p.881-887
• Main Authors: van Oostenbrugge, Tim J., Kroeze, Stephanie G. C., Bosch, J. L. H. Ruud, van Melick, Harm H. E.
• Format: Article
• Language: English
• Subjects: Aged; Carcinoma, Renal Cell - pathology; Carcinoma, Renal Cell - surgery; Cohort Studies; Female; Humans; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local - diagnosis; Neoplasm Staging; Nephrectomy; Nephrology; Nephrons; Oncology; Organ Sparing Treatments; Original Article; Postoperative Care; Retrospective Studies; Time Factors; Urology
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-014-1390-6

Purpose This study was conducted to identify time to and type of recurrence in relation to scheduled follow-up (FU) imaging after nephrectomy or nephron-sparing surgery for localized renal cell carcinoma (RCC). Using this information, future guidelines could improve the early detection of metastases. Methods Measured from moment of treatment, all recurrences after (partial) nephrectomy performed between 2000 and 2010 were categorized as being detected early (5 year for T1/T2 and >10 year for T3/T4), or intermediate (time within those two) based on European Association of Urology (EAU) guidelines. Also symptomatic presentation was screened. Results Recurrent disease developed in 80 of 396 patients after (partial) tumor nephrectomy. Mean time to recurrence in months was 56 ( n  = 21) for T1, 24 ( n  = 18) for T2, 21 ( n  = 38) for T3, and 11 ( n  = 2) for T4 tumors. Detection of early recurrence occurred in 22 patients (28 %), of which 20 (91 %) were T2–T4 tumors. In 10 (48 %) of T1 tumors, late recurrence was found. Of the patients with symptoms due to recurrence, 65 % (17/26) were detected outside the FU surveillance protocol ( P  = 0.01). Conclusion A more intensive FU the first 6 months after nephrectomy for T2–T4 and FU imaging ≥5 years after surgery for T1 tumors might improve early and asymptomatic detection of recurrent disease after nephrectomy for RCC.