ACS 2019: Atypical Patterns and Timing of Recurrences after Minimally Invasive Surgery for Localized Kidney Cancer

San Francisco, California ( Dr. Paul Russo reviewed that after open resection of localized renal cell carcinoma (RCC), 11% of patients will recur with 1% having local recurrence at 60 months. Over the last 15-years they have managed patients treated with minimally-invasive-surgery (MIS) who developed unusual patterns of recurrence. Recently, the FDA released a cautionary statement regarding robotic-assisted devices in cancer-related surgeries, stating that its effectiveness and safety have not been established.  They began compiling these atypical recurrence cases after kidney-cancer surgery and describe their clinical characteristics and outcomes.

Patients managed with robotic-assisted or laparoscopic nephrectomy for localized RCC (stage 1-3) between 2003-2017 at a single institution were identified. Atypical recurrences were defined as early recurrence (<2 years), or an unusual intraabdominal location (nephrectomy-bed, port-site, psoas, abdominal-wall, bowel). Kaplan-Meier method was used to report recurrence-free-survival (RFS).

In 28 patients, (median age 59-years) 20 were male, 15 had clear-cell RCC, 15 were robotic-assisted and 11 had radical nephrectomies. At surgery, stage 1, 2 and 3 was present in 16(57%), 3(11%), and 9(32%), respectively. Academic centers performed MIS in 21(75%) cases. Unusual sites of recurrence included carcinomatosis (14%), isolated soft-tissue (19%) and organ implants (52%) including liver, large-small bowel, spleen, omentum and port-sites (15%). Additional interventions (resections/systemic-agents) were required in 22 (81%). Median RFS was 9 months. Stage-1 progressing to stage-4 in 57%. Median follow-up was 43.5 months. Five patients are NED.

In summary, MIS-treated kidney cancer patients may experience earlier recurrence or unusual sites of intraperitoneal disease. An investigation into the etiology and frequency of these non-stereotypical patterns of recurrence is required and ongoing. Important to note was lack of operative information as well as pathologic information such as original tumor resection, denudation, tumor spillage, positive margins which may impact these findings and warrant further investigation as Dr. Russo noted.

Presented by: Paul Russo, MD, FACS, Memorial Sloan Kettering Cancer Center, New York, New York

Written by: Stephen B. Williams, MD, Medical Director for High Value Care; Chief of Urology, Associate Professor, Director of Urologic Oncology, Director Urologic Research, The University of Texas Medical Branch at Galveston, TX at the 2019 American College of Surgeons (ACS), #ACSCC19, October 27–31 in San Francisco, California