Long-term management of bilateral, multifocal, recurrent renal carcinoma.
Patients with bilateral multifocal renal cell carcinoma are at increased risk of developing locally recurrent or de novo tumors after nephron-sparing procedures. When dealing with recurrent renal masses the options are limited to observation, total nephrectomy, ablation, or repeat surgical intervention. The main reason for recurrence after nephron-sparing surgery is likely to be the presence of multifocal disease, which is identified in 4.3-25.0% of radical nephrectomy specimen. Bilateral renal involvement is seen in almost 90% of cases of multifocal renal carcinoma, and conversely the majority of patients with bilateral disease will have multifocal tumors. Many patients who are treated for multifocal disease, therefore, require subsequent surgical interventions. The outcome data for repeat renal interventions demonstrate reasonable functional and oncologic outcomes despite higher rates of perioperative complications. Our own results support the use of reoperative renal surgery rather than total nephrectomy and renal replacement therapy.
Bratslavsky
Gennady
G
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-1414, USA. bratslag@mail.nih.gov <bratslag@mail.nih.gov>
Linehan
W Marston
WM
D000465:Algorithms; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D009392:Nephrectomy; D017582:Renal Replacement Therapy; D012086:Reoperation
CA Cancer J Clin. 2009 Jul-Aug;59(4):225-49
19474385
Eur Urol. 2008 Oct;54(4):855-63
18487007
J Urol. 1995 Dec;154(6):2010-4; discussion 2014-5
7500446
BJU Int. 2007 Jul;100(1):21-5
17433034
J Urol. 2008 Jul;180(1):104-9; discussion 109
18485401
Hinyokika Kiyo. 1995 Sep;41(9):725-9
7484540
J Urol. 2004 Jan;171(1):130-4
14665860
Am J Kidney Dis. 1998 Nov;32(5 Suppl 3):S112-9
9820470
Am J Transplant. 2001;1 Suppl 2:3-95
12108435
BJU Int. 2010 Apr;105(8):1093-7
19751262
Urol Clin North Am. 1993 May;20(2):207-16
8098558
BJU Int. 1999 Sep;84(4):405-11
10468753
J Clin Oncol. 2009 Aug 10;27(23):3731-3
19597019
J Urol. 1995 Sep;154(3):968-70; discussion 970-1
7637103
J Urol. 1980 Dec;124(6):910-2
7441848
J Urol. 1993 Mar;149(3):461-4
8437247
J Urol. 1986 Oct;136(4):789-91
3761431
Clin Transplant. 2006 Mar-Apr;20(2):245-52
16640534
J Urol. 2004 Feb;171(2 Pt 1):615-20
14713772
J Urol. 1995 Jun;153(6):1812-6
7752324
J Urol. 1982 Nov;128(5):913-5
7176050
N Engl J Med. 2004 Sep 23;351(13):1296-305
15385656
Urology. 1995 Aug;46(2):161-4
7624986
J Urol. 1991 Nov;146(5):1221-3
1942266
Urol Clin North Am. 2003 Nov;30(4):843-52
14680319
BJU Int. 2008 Jun;101(11):1375-9
18454793
Clin Cancer Res. 2004 Sep 15;10(18 Pt 2):6282S-9S
15448018
BJU Int. 2004 Dec;94(9):1323-8
15610114
J Urol. 2004 Jul;172(1):63-5
15201738
J Urol. 2009 Nov;182(5):2158-63
19758659
Transplant Rev (Orlando). 2008 Jan;22(1):21-6
18631855
Urology. 2004 Sep;64(3):462-7
15351571
Urologe A. 2001 Mar;40(2):114-20
11315585
Am J Kidney Dis. 2006 Sep;48(3):392-401
16931212
J Urol. 2001 Feb;165(2):397-400
11176381
Anticancer Res. 2002 Sep-Oct;22(5):3103-7
12530051
J Urol. 2002 Aug;168(2):454-9
12131287
Ann Intern Med. 2006 Oct 3;145(7):512-9
17015869
J Urol. 1995 Mar;153(3 Pt 1):620-2
7861498
Cancer. 1994 Nov 1;74(9):2541-5
7923011
Urol Int. 1999;63(3):160-3
10738186
J Urol. 2007 Jun;177(6):2081-6; discussion 2086-7
17509291
Ann Surg Oncol. 1998 Sep;5(6):548-52
9754765
J Urol. 1995 Mar;153(3 Pt 2):904-6
7853571
J Urol. 2008 Jan;179(1):67-70
17997447
Clin Ther. 2009 Apr;31(4):880-8
19446160
Adv Urol. 2008;:518091
18645615
J Urol. 2008 Feb;179(2):468-71; discussion 472-3
18076931
J Urol. 2001 Mar;165(3):777-81
11176466
Clin Transpl. 2005;:101-9
17424728
J Urol. 2002 Dec;168(6):2632-6
12441999
Mayo Clin Proc. 2000 Oct;75(10):1020-6
11040850
Lancet Oncol. 2006 Sep;7(9):735-40
16945768
J Urol. 2000 May;163(5):1424-7
10751849
J Urol. 1994 Dec;152(6 Pt 1):1984-7
7966656
J Urol. 1988 Jul;140(1):22-4
3379689
J Urol. 2000 Feb;163(2):431-3
10647647
J Urol. 2008 Jul;180(1):89-93; discussion 93
18485404
JAMA. 1999 May 5;281(17):1628-31
10235157
J Urol. 1998 Apr;159(4):1144-7
9507818
Urol Int. 2000;64(4):192-7
10895084
J Urol. 1981 Sep;126(3):313-5
7277587
J Urol. 2008 Mar;179(3):853-6
18221957
J Urol. 2009 Jan;181(1):55-61; discussion 61-2
19012918
J Urol. 2003 Apr;169(4):1276-81
12629342
Urology. 2003 May;61(5):921-5
12736005
J Natl Cancer Inst. 2006 Sep 20;98(18):1331-4
16985252
J Urol. 2005 Sep;174(3):855-8
16093969
Am J Surg Pathol. 2002 Dec;26(12):1542-52
12459621
Curr Urol Rep. 2005 Feb;6(1):7-18
15610692
J Urol. 2004 May;171(5):1814-8
15076283
J Urol. 1998 Apr;159(4):1163-7
9507823
J Urol. 1999 May;161(5):1475-9
10210376
Clin J Am Soc Nephrol. 2009 Jul;4(7):1239-45
19541814
Am J Med. 1987 Feb;82(2):236-8
3812515
J Urol. 2004 Jul;172(1):58-62
15201737
Eur Urol. 2004 Jun;45(6):749-53
15149747
J Urol. 1995 Mar;153(3 Pt 2):913-6
7853573
Circulation. 2003 Oct 28;108(17):2154-69
14581387
J Urol. 2000 Jul;164(1):36-9
10840419
J Urol. 1977 Apr;117(4):534-6
850326