title: Feasibility and oncological outcomes of laparoscopic treatment for local relapse of renal cell carcinoma.
abstract: What's known on the subject? and what does the study add?: Local relapse of renal cell carcinoma following radical nephrectomy is rare, and surgical removal provides the only opportunity for cure. Open surgery has been established as the usual approach for these tumours. It is, however, associated with significant morbidity. Our study describes the largest series of laparoscopic treatment of local relapse of renal cell carcinoma with the longest follow-up. We show that the laparoscopic approach is feasible in expert centres. It provides faster recovery and fewer complications with satisfactory oncological outcomes in selected patients.
  
  
  OBJECTIVE
  To assess the feasibility and oncological outcomes of laparoscopic treatment for local relapse of renal cell carcinoma.
  
  
  METHODS
  Nine patients were treated by a pure laparoscopic approach for local recurrence of a renal tumour between 2005 and 2011 by a single surgeon (HB), following an initial open radical nephrectomy for the primary tumour. Clinical and histopathological data were collected prospectively and analysed retrospectively. Seven patients were treated by a transperitoneal approach and two patients had a retroperitoneal approach.
  
  
  RESULTS
  Relapse occurred within a mean time of 83 months (7-168) following nephrectomy. Recurrent tumour size varied from 2.5 to 4.5 cm. All surgeries were performed laparoscopically without need for conversion. Mean operative duration was 144 min (40-240), mean estimated blood loss was 430 mL (50-1300) and mean hospital stay was 4.5 days (3-6). Three patients had Clavien grade I intraoperative complications. Late complications were noted in two patients (Clavien I and IIIb). Pathology confirmed clear cell carcinoma in all patients with an absence of sarcomatoid features and negative surgical margins. Three patients had neoadjuvant treatment and two patients had adjuvant treatment. In all, 67% of patients were disease free with a mean follow-up period of 3 years.
  
  
  CONCLUSIONS
  Surgical removal of isolated local recurrence remains the only possibility of cure in patients with renal cell carcinoma. We demonstrated that the laparoscopic approach is a safe and feasible alternative treatment option for selected cases with low morbidity and satisfactory oncological outcomes.
authors.affiliation: Department of Urology, Paris Saint Joseph Hospital Trust, Paris, France. alberthajj@gmail.com
authors.forename: Albert
authors.initials: A
authors.lastname: El Hajj
authors.forename: Ruban
authors.initials: R
authors.lastname: Thanigasalam
authors.forename: Vincent
authors.initials: V
authors.lastname: Molinié
authors.forename: Walid
authors.initials: W
authors.lastname: Massoud
authors.forename: Mohamed
authors.initials: M
authors.lastname: Fourati
authors.forename: Frederic
authors.initials: F
authors.lastname: Girard
authors.forename: Bernard
authors.initials: B
authors.lastname: Escudier
authors.forename: Hervé
authors.initials: H
authors.lastname: Baumert
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005240:Feasibility Studies; 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
keywords: laparoscopic; local relapse; renal cell carcinoma