Renal cell carcinoma: The role of radical surgery on different patterns of local or distant recurrence

• Published in: Surgical oncology 2020-12, Vol.35, p.106-113
• Main Authors: Di Franco, Gregorio, Palmeri, Matteo, Sbrana, Andrea, Gianardi, Desirée, Furbetta, Niccolò, Guadagni, Simone, Bianchini, Matteo, Stefanini, Gianni, Adamo, Giulia, Pollina, Luca Emanuele, Galli, Luca, Di Candio, Giulio, Morelli, Luca
• Format: Article
• Language: English
• Subjects: Ablation; Cancer; Cancer therapies; Distant RCC recurrence; Immunotherapy; Kidney cancer; Local RCC recurrence; Lymphatic system; Medical prognosis; Metastases; Metastasis; Mortality; Patients; RCC recurrence; Renal cell carcinoma; Statistical analysis; Surgery; Survival; Tumors
• ISSN: 0960-7404; 1879-3320
• DOI: 10.1016/j.suronc.2020.08.002

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. 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. 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). 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. •Surgical resection should be performed when an R0 resection could be obtained.•Surgery could be taken in consideration both for local and distant RCC recurrences.•Surgery may offer a potentially long survival in selected patient with RCC recurrence.•Surgery could be taken in consideration also in case of further RCC recurrences.