title: The blind spots in follow-up after nephrectomy or nephron-sparing surgery for localized renal cell carcinoma.
abstract: OBJECTIVE
  This study was conducted to identify time to and type of recurrence in relation to scheduled follow-up (FU) imaging after nephrectomy or nephron-sparing surgery for localized renal cell carcinoma (RCC). Using this information, future guidelines could improve the early detection of metastases.
  
  
  METHODS
  Measured from moment of treatment, all recurrences after (partial) nephrectomy performed between 2000 and 2010 were categorized as being detected early (<6 months), late (>5 year for T1/T2 and >10 year for T3/T4), or intermediate (time within those two) based on European Association of Urology (EAU) guidelines. Also symptomatic presentation was screened.
  
  
  RESULTS
  Recurrent disease developed in 80 of 396 patients after (partial) tumor nephrectomy. Mean time to recurrence in months was 56 (n = 21) for T1, 24 (n = 18) for T2, 21 (n = 38) for T3, and 11 (n = 2) for T4 tumors. Detection of early recurrence occurred in 22 patients (28%), of which 20 (91%) were T2-T4 tumors. In 10 (48%) of T1 tumors, late recurrence was found. Of the patients with symptoms due to recurrence, 65% (17/26) were detected outside the FU surveillance protocol (P = 0.01).
  
  
  CONCLUSIONS
  A more intensive FU the first 6 months after nephrectomy for T2-T4 and FU imaging ≥5 years after surgery for T1 tumors might improve early and asymptomatic detection of recurrent disease after nephrectomy for RCC.
authors.affiliation: Department of Urology, Radboud University Medical Center, P.O. box 9101, 6525 GA, Nijmegen, The Netherlands, tim.vanoostenbrugge@radboudumc.nl.
authors.forename: Tim J
authors.initials: TJ
authors.lastname: van Oostenbrugge
authors.forename: Stephanie G C
authors.initials: SG
authors.lastname: Kroeze
authors.forename: J L H Ruud
authors.initials: JL
authors.lastname: Bosch
authors.forename: Harm H E
authors.initials: HH
authors.lastname: van Melick
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009367:Neoplasm Staging; D009392:Nephrectomy; D009399:Nephrons; D059351:Organ Sparing Treatments; D011182:Postoperative Care; D012189:Retrospective Studies; D013997:Time Factors