title: Surgical Management of Local Retroperitoneal Recurrence of Renal Cell Carcinoma after Radical Nephrectomy.
abstract: OBJECTIVE
  Isolated local retroperitoneal recurrence after radical nephrectomy for renal cell carcinoma poses a therapeutic challenge. We investigated outcomes in patients with localized retroperitoneal recurrence treated with surgical resection.
  
  
  METHODS
  This was a retrospective, single institutional study of 102 patients with retroperitoneal recurrence treated with surgery from 1990 to 2014. Demographics, clinical and pathological features, location of retroperitoneal recurrence and perioperative complications are reported using descriptive statistics. We studied recurrence-free and cancer specific survival using univariate and multivariate analyses.
  
  
  RESULTS
  Median age at retroperitoneal recurrence diagnosis was 55 years (IQR 49-64). Cancer was pT3-4 in 62 patients (60.8%) and pN1 in 20 (19.6%). No patients had distant metastatic disease at retroperitoneal recurrence surgery. Median time from nephrectomy to retroperitoneal recurrence diagnosis was 19 months (IQR 5-38.8). The median size of the resected retroperitoneal recurrence was 4.5 cm (IQR 2.7-7). Median followup after recurrence surgery was 32 months (IQR 16-57). Metastatic progression was observed in 60 patients (58.8%) postoperatively. Neoadjuvant and salvage systemic therapy was administered in 46 (45.1%) and 48 patients (47.1%), respectively. On multivariate analysis pathological nodal stage at original nephrectomy and maximum diameter of retroperitoneal recurrence were identified as independent risk factors for cancer specific death.
  
  
  CONCLUSIONS
  Clinicopathological factors at nephrectomy as well as retroperitoneal recurrence surgery are important prognosticators. Aggressive surgical resection offers potential cure in a substantial number of patients with retroperitoneal recurrence with acceptable complications and still has a dominant role in the management of isolated locally recurrent RCC.
authors.affiliation: Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Arun Z
authors.initials: AZ
authors.lastname: Thomas
authors.affiliation: Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Mehrad
authors.initials: M
authors.lastname: Adibi
authors.affiliation: Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Leonardo D
authors.initials: LD
authors.lastname: Borregales
authors.affiliation: Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Ly N
authors.initials: LN
authors.lastname: Hoang
authors.affiliation: Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Pheroze
authors.initials: P
authors.lastname: Tamboli
authors.affiliation: Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Eric
authors.initials: E
authors.lastname: Jonasch
authors.affiliation: Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Nizar M
authors.initials: NM
authors.lastname: Tannir
authors.affiliation: Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Surena F
authors.initials: SF
authors.lastname: Matin
authors.affiliation: Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wood
authors.affiliation: Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: JAKaram@mdanderson.org.
authors.forename: Jose A
authors.initials: JA
authors.lastname: Karam
mesh_terms: D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000601:surgery*; D009367:Neoplasm Staging; D009392:Nephrectomy; D012086:Reoperation; D012186:Retroperitoneal Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome
keywords: carcinoma; kidney; local; lymph nodes; neoplasm recurrence; nephrectomy; renal cell