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Renal fossa recurrence after radical nephrectomy: Current management, and oncological outcomes. Urol Oncol 2019; 38:42.e7-42.e12. [PMID: 31711833 DOI: 10.1016/j.urolonc.2019.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 07/30/2019] [Accepted: 10/07/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Kidney cancers represent 2% of cancers worldwide; the most common type is renal clear cell carcinoma (RCC). Surgical treatment remains the only effective therapy for localized renal cell carcinoma. Approximately 20% to 38% of patients undergoing radical nephrectomy (RN) for localized RCC will have subsequent disease progression, with 0.8% to 3.6% of local recurrences within the ipsilateral retroperitoneum (RFR). The main objective of this study is to evaluate prognostic features, oncological outcomes, and current management for renal fossa recurrence in patients with history of RN for RCC. MATERIALS AND METHODS We retrospectively analyzed 733 patients who underwent open or laparoscopic RN for unilateral T1-T4 N0 M0 RCC between 2010 and 2016 at the Urology Department of Hospital Italiano de Buenos Aires. RESULTS During the mentioned period, of a total of 733 RNs (open/laparoscopic), 561 patients with RCC were included in the study. After a median follow-up time of 24 months (12-36) (interquartile range), 21 (3.74%) patients out of 561, developed renal fossa recurrence. Of these, 13 (2.31%) patients were diagnosed with isolated local renal fossa recurrence and different treatment approaches were adopted; 11 patients underwent open surgical resection, 1 patient laparoscopic surgical resection, and 1 case was treated with cryoablation. Regarding cancer-specific survival, estimated 4-year cancer-specific survival in patients without RFR, with isolated RFR (iRFR) and not isolated RFR (niRFR) was 82.7% (CI 95% 70.2-95.2), 69.2% (IC 44.2-94.2) and 0%, respectively (log rank test P < 0.0001 being niRFR group different to others. Non isolated RFR was a death risk factor with a HR of 11.4 (4.8-27.2) compared with iRFR or no recurrence. Overall, 51% (IC 26.6-71.2) of patients with any RFR died at 4 years follow-up. CONCLUSION Although RFR is a rare condition, in the absence of distant metastatic disease, aggressive surgical resection should be our aim. High pathological tumoral stage at original nephrectomy and high tumoral grade are independent risk factors for RFR. This group of patients needs closer follow-up to detect earlier recurrences and decide a treatment strategy.
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Farrokh D, Rad MP, Mortazavi R, Akhavan R, Abbasi B. Local recurrence of renal cell carcinoma presented with massive gastrointestinal bleeding: management with renal artery embolization. CVIR Endovasc 2019; 2:10. [PMID: 32026999 PMCID: PMC6966418 DOI: 10.1186/s42155-019-0054-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 02/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gastrointestinal bleeding from renal cell carcinoma metastasis is an uncommon manifestation of tumor recurrence and is usually difficult to control. Palliative trans-catheter embolization to control the bleeding has been used and described in the literature. CASE PRESENTATION The present report describes a 62- years-old male with local recurrence of RCC who presented with upper GI bleeding as the primary manifestation 10 years after right-sided partial nephrectomy. A pseudoaneurysm of renal artery with erosion into the duodenal lumen was responsible for the massive bleeding and was controlled with coil embolization. CONCLUSION This case report highlights the importance of high index suspicion in post-nephrectomy patients for RCC, presenting with new symptoms. Aggressive gastrointestinal workup and adequate awareness of available minimally-invasive endovascular options for controlling GIB in these patients, are of paramount importance.
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Affiliation(s)
- Donya Farrokh
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Imam Reza hops, Razi Sq, Mashhad, Iran
| | - Masoud Pezeshki Rad
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Imam Reza hops, Razi Sq, Mashhad, Iran
| | - Reihaneh Mortazavi
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Imam Reza hops, Razi Sq, Mashhad, Iran
| | - Reza Akhavan
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bita Abbasi
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Imam Reza hops, Razi Sq, Mashhad, Iran.
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Ulutin HC, Aksu G, Fayda M, Kuzhan O, Tahmaz L, Beyzadeoglu M. The Value of Postoperative Radiotherapy in Renal Cell Carcinoma: A Single-Institution Experience. TUMORI JOURNAL 2018; 92:202-6. [PMID: 16869236 DOI: 10.1177/030089160609200303] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim To evaluate the efficacy of postoperative irradiation in renal cell carcinoma. Patients and methods Forty patients with localized renal cell carcinoma admitted to our hospital between 1986 and 1999 were evaluated. All patients were initially treated with radical nephrectomy. Postoperative radiotherapy was given to 26 of 40 patients (65%). Fourteen patients (35%) received no adjuvant therapy. Median age was 55 years (range, 20–70 years). Twenty-four patients (60%) were men and 16 patients (40%) were women. Histopathological diagnosis was renal cell carcinoma in all of the patients. N+ disease was present in 3 patients (7%). Stage I and II disease was present in 25 patients (63%) and stage III and IV disease in 15 patients (37%). Two patients (5%) had T1a disease, 11 patients (27%) had T1b, 15 patients (38%) had T2, 11 patients (27%) had T3a and 1 (3%) patient had T3b. In the radiotherapy group, renal bed and regional lymphatic fields were irradiated with daily fractions of 180–200 cGy/fraction to a total dose of 46–50 Gy, using parallel opposing fields. Results The 5-year overall survival rates were 70% in the postoperative radiotherapy group and 20% in the no adjuvant treatment group, showing no significant difference (P = 0.1). The 5-year disease-free survival rates were 66% in the radiotherapy group and 16% in the no treatment group, with a significant difference in both univariate and multivariate analyses (P = 0.045 and P = 0.0007, respectively). Stage III and IV disease, tumor size ≥7 cm, presence of distant metastasis and lactate dehydrogenase level >450 U/L were found to be adverse prognostic factors for overall survival in both univariate and multivariate analyses. Analyzing the factors affecting disease-free survival, absence of postoperative radiotherapy and tumor size ≥7 cm were found to be adverse prognostic factors in univariate and multivariate analyses. Conclusion Multi-institutional prospective randomized trials using modern radiotherapy techniques such as conformal radiotherapy and intensity-modulated radiotherapy are necessary to evaluate the real role of radiotherapy and its effect on survival in renal cell carcinoma, especially in selected patients with a high risk of local or regional failure.
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Affiliation(s)
- H Cuneyt Ulutin
- Radiotherapy Department, Gulhane Military Faculty of Medicine, Ankara, Turkey.
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Abstract
The metastasis of neoplastic cells from their site of origin to distant anatomic locations continues to be the principal cause of death from malignant tumors, and that fact has been recognized by physicians for over a century. After the work done by Halsted in the treatment of breast cancer in the 1880s, accepted surgical canon held that metastasis occurred in a linear fashion, with centrifugal "growth in continuity" from the primary neoplasm that first involved regional lymph nodes. Those structures were considered to then be the sources of more distant, visceral metastases. With that premise in mind, radical and "ultra-radical" surgical procedures were devised to remove as many lymph nodes as possible in the treatment of carcinomas and melanomas. However, such interventions were ineffective in altering tumor-related mortality. This review considers the details of the historical material just mentioned. It also reviews currently-held concepts on biological mechanisms of metastasis, the "sentinel" lymph node biopsy technique, and the important topic of metastatic tumor "dormancy" as the cause of surgical treatment failure. Finally, predictive models of tumor behavior are discussed, which are based on gene signatures. These will likely be the key to identifying malignant lesions of low surgical stage that ultimately prove fatal through later manifestation of metastasis.
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Affiliation(s)
- Mark R Wick
- Division of Surgical Pathology & Cytopathology, Department of Pathology, University of Virginia Medical Center, Room 3020, 1215 Lee Street, Charlottesville, VA 22908-0214, United States.
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Hilton S, Jones LP. Recent Advances in Imaging Cancer of the Kidney and Urinary Tract. Surg Oncol Clin N Am 2014; 23:863-910. [DOI: 10.1016/j.soc.2014.06.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Girish G, Finlay K, Fessell D, Pai D, Dong Q, Jamadar D. Imaging review of skeletal tumors of the pelvis malignant tumors and tumor mimics. ScientificWorldJournal 2012; 2012:240281. [PMID: 22593667 PMCID: PMC3349129 DOI: 10.1100/2012/240281] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 11/30/2011] [Indexed: 11/18/2022] Open
Abstract
Malignant lesions of the pelvis are not uncommon and need to be differentiated from benign lesions and tumor mimics. Appearances are sometimes nonspecific leading to consideration of a broad differential diagnosis. Clinical history, anatomic location, and imaging characterization can help narrow the differential diagnosis. The focus of this paper is to demonstrate the imaging features and the role of plain films, computed tomography, and magnetic resonance imaging for detecting and characterizing malignant osseous pelvic lesions and their common mimics.
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Affiliation(s)
- Gandikota Girish
- Department of Radiology, University of MI, 1500 E. Medical Center Drive, TC-2910, Ann Arbor, MI 48109-0326, USA.
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Jadav AM, Thrumurthy SG, DeSousa BA. Solitary colonic metastasis from renal cell carcinoma presenting as a surgical emergency nine years post-nephrectomy. World J Surg Oncol 2010; 8:54. [PMID: 20587023 PMCID: PMC2902475 DOI: 10.1186/1477-7819-8-54] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 06/29/2010] [Indexed: 11/20/2022] Open
Abstract
Late colonic metastasis following curative surgery for renal cell carcinoma has rarely been described. We present the first reported case of solitary colonic renal cell carcinoma metastasis presenting as an intra-abdominal bleed, nine years post-nephrectomy.
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Affiliation(s)
- Alka M Jadav
- Department of Lower Gastrointestinal Surgery, Royal Preston Hospital, Preston, PR2 9HT, UK
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Tanimoto S, Fukumori T, El-Moula G, Shiirevnyamba A, Kinouchi S, Koizumi T, Nakanishi R, Yamamoto Y, Taue R, Yamaguchi K, Nakatsuji H, Kishimoto T, Izaki H, Oka N, Takahashi M, Kanayama HO. Prognostic significance of serum hepatocyte growth factor in clear cell renal cell carcinoma: comparison with serum vascular endothelial growth factor. THE JOURNAL OF MEDICAL INVESTIGATION 2008; 55:106-11. [PMID: 18319552 DOI: 10.2152/jmi.55.106] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
No adequate serum predictive biomarker currently exists, which can identify the activity of renal cell carcinoma (RCC). We investigate the association of serum hepatocyte growth factor (HGF) and serum vascular endothelial growth factor (VEGF) levels with clinicopathologic parameters in untreated clear cell RCC patients. We measured serum levels of HGF and VEGF in 45 patients with untreated clear cell RCC and 45 healthy controls using an enzyme-linked immunosorbent assay (ELISA). Patients with clear cell RCC had significantly higher serum HGF and VEGF concentrations than healthy subjects: median, 1070.7 versus 728.3 pg/ml (p<0.0001) for HGF; and median, 397.5 versus 245.6 pg/ml (p=0.0003) for VEGF. We found a significant correlation between serum level of HGF and clinical stage and tumor grade. Survival of patients with high serum HGF (>1150 pg/ml) was significantly reduced compared to patients with low serum HGF concentrations (p=0.0044). In patients with nuclear grade 2 or high stage RCC, the higher serum HGF group exhibited significantly lower cause-specific survival (p=0.0087 and p< 0.05, respectively). No significant difference was observed between serum VEGF levels and cause-specific survival rate. Serum HGF might be a diagnostic and prognostic indicator in clear cell RCC, especially for patients with grade 2 or high stage RCC.
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Affiliation(s)
- Shuji Tanimoto
- Department of Urology, Takamatsu Red Cross Hospital, Tokushima, Japan
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Perdonà S, Autorino R, Gallo L, DE Sio M, Marra L, Claudio L, Caracò C, Franco R, Fazzioli F, Gallo A. Renal cell carcinoma with solitary toe metastasis. Int J Urol 2005; 12:401-4. [PMID: 15948730 DOI: 10.1111/j.1442-2042.2005.01060.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Solitary metastases to the small bones and/or to the soft tissue of the hands and feet (acrometastases) are rare. We report a case of renal cell carcinoma (RCC) with big toe metastasis revealed before the primary tumor became apparent. The best treatment for a single metastasis is always surgical excision, regardless of the lesion being synchronous or metachronous. The biological behavior of metastatic RCC is unpredictable and only early diagnosis and treatment may favorably affect patient survival. Thus, metastatic RCC should be included in the differential diagnosis of all enlarging cutaneous nodules, wherever they develop.
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Affiliation(s)
- Sisto Perdonà
- Department of Urology, National Cancer Institute, I.R.C.C.S. Fondazione 'G.Pascale', Naples, Italy.
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Outcome Of Surgical Treatment Of Isolated Local Recurrence After Radical Nephrectomy For Renal Cell Carcinoma. J Urol 2002. [DOI: 10.1097/00005392-200204000-00013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Schrödter S, Hakenberg OW, Manseck A, Leike S, Wirth MP. Outcome Of Surgical Treatment Of Isolated Local Recurrence After Radical Nephrectomy For Renal Cell Carcinoma. J Urol 2002. [DOI: 10.1016/s0022-5347(05)65167-1] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Steffen Schrödter
- From the Department of Urology, University Hospital Carl-Gustav Carus, Dresden, Germany
| | - Oliver W. Hakenberg
- From the Department of Urology, University Hospital Carl-Gustav Carus, Dresden, Germany
| | - Andreas Manseck
- From the Department of Urology, University Hospital Carl-Gustav Carus, Dresden, Germany
| | - Steffen Leike
- From the Department of Urology, University Hospital Carl-Gustav Carus, Dresden, Germany
| | - Manfred P. Wirth
- From the Department of Urology, University Hospital Carl-Gustav Carus, Dresden, Germany
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Uchida K, Miyao N, Masumori N, Takahashi A, Oda T, Yanase M, Kitamura H, Itoh N, Sato M, Tsukamoto T. Recurrence of renal cell carcinoma more than 5 years after nephrectomy. Int J Urol 2002; 9:19-23. [PMID: 11972645 DOI: 10.1046/j.1442-2042.2002.00418.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES We evaluated clinical features and predictive factors for the recurrence of renal cell carcinoma (RCC) developing more than 5 years after nephrectomy. METHODS We retrospectively reviewed 239 patients with RCC who underwent surgery for the primary lesion. To identify factors that affected recurrence more than 5 years after nephrectomy (delayed recurrence) and its clinical outcomes, we performed a multivariate analysis using Cox's proportional hazards model and a survival study. RESULTS Recurrence developing within 5 years after nephrectomy (early recurrence) was found in 57 patients and delayed recurrence in 11 patients. The multivariate analysis revealed no clinical and pathologic features influencing delayed recurrence in 114 patients who survived more than 5 years after nephrectomy without having early recurrence. The patients with delayed recurrence showed better clinical outcomes than those with early recurrence when the rate was determined from the time of recurrence. CONCLUSIONS Although delayed recurrence is not a rare event for patients with RCC, no clinical and pathologic factors at the time of the initial treatment can predict the recurrence. Patients who are free of recurrence for more than 5 years after surgery for a primary lesion should be carefully followed up for delayed recurrence.
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Affiliation(s)
- Kohsuke Uchida
- Department of Urology (Clinical Pathology Division), Sapporo Medical University School of Medicine, Japan
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Scatarige JC, Sheth S, Corl FM, Fishman EK. Patterns of recurrence in renal cell carcinoma: manifestations on helical CT. AJR Am J Roentgenol 2001; 177:653-8. [PMID: 11517065 DOI: 10.2214/ajr.177.3.1770653] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- J C Scatarige
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD 21287, USA
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Abstract
OBJECTIVES To present cases of renal cell carcinoma presenting with only head and neck metastases, to review theories of physiology and anatomy describing this phenomenon, and to discuss the role of the otolaryngologist in the treatment of these lesions. STUDY DESIGN Retrospective review of the records of three patients who presented with renal cell carcinoma with head and neck metastases over the 3-year period from 1992 to 1995. METHODS Retrospective review of the records of three patients who presented with renal cell carcinoma with head and neck metastases. In addition, English-language literature was reviewed with special focus on the anatomic and physiologic pathways possible to allow for such a phenomenon. CONCLUSIONS Renal cell carcinoma has an occasional presentation as a head and neck mass without evidence of disease elsewhere. Various routes of spread have been postulated. Batson's venous plexus, as postulated by Nahum and Bailey, is an anatomic route through which emboli could navigate to the head and neck and avoid pulmonary vascular filtration. Interactions on the cellular level may also be responsible for the seemingly paradoxical spread. We recommend local excision of head and neck metastases of renal cell carcinoma without sacrifice of vital structures as a sound treatment regimen.
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Affiliation(s)
- M D Gottlieb
- Department of Otolaryngology, New York University School of Medicine, New York 10016, USA
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Tapper H, Klein H, Rubenstein W, Intriere L, Choi Y, Kazam E. Recurrent renal cell carcinoma after 45 years. Clin Imaging 1997; 21:273-5. [PMID: 9215475 DOI: 10.1016/s0899-7071(96)00042-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Late recurrence of renal cell carcinoma (RCC), arbitrarily defined as > 10 years post nephrectomy, is rare. The longest known clinical disease-free interval of 36 years was reported by Walter and Gellespie in 1960. We report a case of recurrent RCC presenting 45 years after nephrectomy.
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Affiliation(s)
- H Tapper
- Department of Diagnostic Radiology, Cornell University Medical Center, New York Hospital, New York 10021, USA
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