title: Laparoscopic resection of tumor recurrence after radical nephrectomy for localized renal cell carcinoma.
abstract: BACKGROUND
  Local recurrence of Renal Cell Carcinoma (RCC) after radical nephrectomy is a rare event. Some known risk factors are: clinical/pathological stage, locorregional disease and lyimph node positivity. Since up to 30-40% of patients can achieve a disease-free status, we show a case (video) in which we performed a laparoscopic excision of a local RCC, taking advantage of all the well-known benefits of laparoscopy.
  
  
  METHODS
  A 56 years old female with a history of open radical nephrectomy two years before was diagnosed with a mass at the time of surveillance CT imaging during follow-up. The suspected local recurrence was 12 cm, and vascularized predominantly by tributaries originating from the iliac vessels. There was no other site of disease (i.e. brain, lung, liver, bones) and laboratory tests were normal. Laparoscopic approach was approached, by inserting 4 trocars (2 of 10 and 2 of 5mm) with the patient in the lateral position.
  
  
  RESULTS
  The procedure lasted 130 minutes, with 220 mL of estimated bleeding; the larger vessels were ligated with polymer clips (Hem-o-lok) and the smaller handled by ultrasonic clamp. The specimen was removed by a small incision below the umbilicus in an appropriate bag. The patient was feed in the first postoperative day and discharged on the third day. Histopathology revealed sarcoma, with a high degree of mitosis, and negative surgical margins. She was referred to medical oncology for adjuvant therapy consideration.
  
  
  CONCLUSIONS
  The laparoscopic resection of recurrent tumor should be encouraged in highly selected cases. The minimally invasive method, with its known advantages, especially for more debilitated patients, can be advantageous when applied to suitable cases.
authors.affiliation: Department of UroOncology, Ipanema Federal Hospital, Rio de Janeiro, RJ, Brazil.
authors.forename: Lessandro
authors.initials: L
authors.lastname: Curcio
authors.affiliation: Department of UroOncology, Ipanema Federal Hospital, Rio de Janeiro, RJ, Brazil.
authors.forename: Antonio Claudio
authors.initials: AC
authors.lastname: Cunha
authors.affiliation: Department of UroOncology, Ipanema Federal Hospital, Rio de Janeiro, RJ, Brazil.
authors.forename: Juan
authors.initials: J
authors.lastname: Renteria
authors.affiliation: Department of UroOncology, Ipanema Federal Hospital, Rio de Janeiro, RJ, Brazil.
authors.forename: Daniel
authors.initials: D
authors.lastname: Presto
mesh_terms: D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D009392:Nephrectomy; D016896:Treatment Outcome