title: Laparoscopic resection of local recurrence after previous radical nephrectomy for clinically localized renal-cell carcinoma: perioperative outcomes and initial observations.
abstract: OBJECTIVE
  Local recurrence is rare after radical nephrectomy for clinically localized renal-cell carcinoma (RCC). Aggressive open surgical resection of isolated local recurrence has been shown to offer durable local control and potential improvement in cancer-specific survival. The objective of this study is to assess early outcomes on a select group of patients who underwent laparoscopic resection of isolated local recurrence after radical nephrectomy for clinically localized RCC.
  
  
  METHODS
  The perioperative and clinical outcomes of four patients who underwent laparoscopic resection of local recurrence between 2007 and 2009 by a single surgeon were reviewed.
  
  
  RESULTS
  Two patients underwent resection of ipsilateral adrenal recurrence while the remaining two underwent resection of recurrence in retroperitoneal lymph nodes. The mean age of patients was 57 years (44-66 y), all had primary tumors with clear-cell histology, and Eastern Cooperative Oncology Group performance status was 0. The mean recurrence size was 5 cm (3-7 cm). All surgical margins were negative. Mean operative time was 195 minutes (170-210 min), and mean estimated blood loss was 187 mL (100-250 mL). No patient needed blood transfusion. Mean length of stay was 2.5 days (2-3 d). At a mean follow-up of 12 months (2-26 mos), 1 patient experienced further recurrence. All patients are alive, and three have no evidence of disease.
  
  
  CONCLUSIONS
  Aggressive surgical resection of isolated local recurrence of RCC after radical nephrectomy with curative intent may be beneficial and has traditionally been performed using open surgery. In our limited experience, a laparoscopic approach may be used in selected patients with small well-circumscribed recurrences with low morbidity and excellent short-term outcomes.
authors.affiliation: James Buchanan Brady Urological Institute, Baltimore, Maryland 21287, USA.
authors.forename: Jithin
authors.initials: J
authors.lastname: Yohannan
authors.forename: Tom
authors.initials: T
authors.lastname: Feng
authors.forename: Jared
authors.initials: J
authors.lastname: Berkowitz
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Connolly
authors.forename: Philip
authors.initials: P
authors.lastname: Pierorazio
authors.forename: Mohamad E
authors.initials: ME
authors.lastname: Allaf
mesh_terms: D000328:Adult; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome