BERKELEY, CA (UroToday Inc.) - Efficacious treatment of renal cell carcinoma is primarily surgical. Some patients recur only in the renal fossa. Management of these patients is usually surgical, but no recent series have been reported.

Dr. Master and associates at the University of California, San Francisco report a contemporary series of renal fossa only recurrence patients. Their findings appear in the August 2005 issue of the Journal of Urology.

Using the University of California, San Francisco Urologic Oncology database, 14 patients were identified as having undergone treatment for a local fossa recurrence for renal cell carcinoma. The group was made up of 10 men and 4 women. The mean age at the time of the initial radial nephrectomy was 51.6 years.

In the original nephrectomy series, 3 cases had positive surgical margins and 1 case had fluid spillage from a large cystic renal cell carcinoma. Surgical pathology was pT1 in 2 patients, pT2 in 2 patients, and pT3 in 10 patients. One patient had lymph node invasion.

Thirteen of the 14 patients presented with asymptomatic cross-sectional imagining suggesting recurrence and one patient was symptomatic. The mean time to recurrence for patients who died was 16 months, as compared to those that did not die which was 83 months.

At surgery the masses tended to have ill-defined margins and often involved adjacent structures that were removed en bloc.

Operative times for fossa resection averaged 450 minutes and the mean blood loss was 1.7 liters. The mean hospital stay was 9.2 days. Complications occurred in 42% of patients, most commonly pancreatic leak following partial pancreatectomy in 4 patients.

Preoperative chemotherapy/immunotherapy was given to 5 patients. Ten patients received intraoperative radiation therapy (IORT).

The mean tumor size was 7.4 cm and 4.5 cm for patients receiving and not receiving IORT, respectively. Two patients developed local fossa re-recurrence, both of whom received IORT.

Mean follow-up was 34 months for the entire cohort. Nine of 14 patients died of disease after surgery with a mean survival of 17 months. Survivors had a mean follow-up 66 months. All deaths were cancer related and 6 of 10 patients who received intraoperative radiation therapy surgery died compared with 3 of 4 patients who had surgery alone. There was no difference in survival due to IORT. In this series 3 of 4 female patients are alive versus 2 of 10 of the male patients.

These data suggest that approximately 30% of patients who have a renal fossa recurrence from renal carcinoma can have a durable response following surgery. These patients are best identified as having a long interval between their primary surgery and their recurrence. IORT did not provide a survival advantage, but the present study may not be large enough to validate this finding.

J. Urol 2005;174:473-477