Outcome of isolated renal cell carcinoma fossa recurrence after nephrectomy

Purpose: Local recurrence of renal cell carcinoma in the renal fossa after complete radical nephrectomy is uncommon. We characterize and determine out come in a small subset of patients. Materials and Methods: From 1970 to 1998 the incidence of isolated renal be d recurrence among 1,737 T1-3N0M0 unilateral nephrectomy cases was 1.8% (st andard error [SE] 0.4) at 5 years. There were 30 patients in whom isolated local fossa carcinoma recurred after complete radical nephrectomy without e vidence of metastatic disease. Patients with any nodal involvement at radic al nephrectomy were excluded from study as were those who had undergone any form of partial nephrectomy. Patient charts were reviewed for clinical pre sentation, stage, treatment, development of metastatic disease and survival . Pathological stage was assigned according to the 1997 TNM staging system. Recurrence was identified in 12 (40%) patients during routine followup and the remaining 18 (60%) presented with symptoms related to the recurrent tu mor. Patients were divided into 3 treatment groups of observation (9), ther apy excluding surgical extirpation (11) and complete surgical resection alo ne or in conjunction with additional therapy (10). Mean time from local rec urrence to development of metastatic disease was calculated. Survival from local recurrence to overall death and disease specific death was estimated using the Kaplan-Meier method. Survival curves for the different treatment groups were then compared. Results: There were 30 patients identified with an ipsilateral renal fossa recurrence of renal cell carcinoma after complete nephrectomy in the absenc e of disseminated disease. Mean followup was 3.3 years (range 0.006 to 14.8 ) and no patient was lost to followup. The T stage of the primary tumor was T1/T2 in 13 cases, T3a in 4, T3b in 12, and T3c in 1, and all were node ne gative. Mean time to metastasis was 1.6 years (range 0.006 to 7.3) in the 1 9 patients who had documented interval metastatic disease after local recur rence. There were 26 deaths, of which 25 were disease specific. Estimated o verall crude and cause specific survival at: 1 and 5 years was 66% and 28%, respectively. Calculating survival among symptomatic and asymptomatic pati ents revealed no discernible difference in outcome (p = 0.94). The S-year s urvival rate with surgical resection was 51% (SE 18) compared to 18% (12) t reated with adjuvant medical therapy and only 13% (12) with observation alo ne. The differences in cause specific survival were significant (p 0.02). Conclusions: Isolated local recurrence is rare with less than a 2% incidenc e at 5-year followup. Presently long-term survival with locally recurrent r enal cell carcinoma is poor with a 28% survival rate at 5 years. However, p atients who underwent surgical resection had an improved 5-year cause speci fic survival rate of 51% compared to 18% treated with adjuvant medical ther apy and 13% with observation alone. This finding suggests that select patie nts may benefit from an aggressive surgical approach.