title: Surgical excision of isolated renal-bed recurrence after radical nephrectomy for renal cell carcinoma.
abstract: OBJECTIVE
  To present our results on managing loco-regional recurrence of renal cell carcinoma (RCC) with surgical excision, as local recurrence at the site of a previous nephrectomy is resistant to both systemic therapy and radiotherapy.
  
  
  METHODS
  In all, 16 patients were operated on between 1994 and 2003 for local recurrence of RCC. The median (mean, range) age at the time of local recurrence was 57.9 (57.4, 28.9-71.7) years, and the median interval from primary surgery 2.22 (3.88, 0.27-14.46) years. Before surgery eight patients had been given systemic immunotherapy, with no response of their local recurrence.
  
  
  RESULTS
  Two patients were deemed inoperable because of direct invasion of the great vessels and the liver by tumour. The remaining 14 patients had recurrence in residual adrenal tissue (two), para-aortic nodes (three), para-caval nodes (two), retrocaval nodes (one), renal bed (six), liver, spleen and stomach (one each), and diaphragm (two). Although complete macroscopic en-bloc clearance was achieved in these patients, only eight had tumour-free margins on histological examination. The histology was consistent with RCC recurrence in all cases. All of the patients were followed with computed tomography at regular intervals. At a median follow-up of 1.0 (1.65, 0.25-6.5) years, five patients remain disease-free, four have local and distant relapse, and five developed distant metastasis only. The presence of tumour at the resection margin was a significant factor in predicting local and distant disease-free survival (P < 0.05).
  
  
  CONCLUSIONS
  En bloc excision of isolated locally recurrent RCC is possible, and complete surgical extirpation can lead to prolonged disease-free survival.
authors.affiliation: The Royal Marsden Hospital, London, UK. sarb@sandhu-one.freeserve.co.uk
authors.forename: Sarbjinder S
authors.initials: SS
authors.lastname: Sandhu
authors.forename: Andrew
authors.initials: A
authors.lastname: Symes
authors.forename: Roger
authors.initials: R
authors.lastname: A'Hern
authors.forename: S A Aslam
authors.initials: SA
authors.lastname: Sohaib
authors.forename: Tim
authors.initials: T
authors.lastname: Eisen
authors.forename: Martin
authors.initials: M
authors.lastname: Gore
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Christmas
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000188:drug therapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000601:surgery*; D009392:Nephrectomy / Q000379:methods*; D016896:Treatment Outcome