Local Tumor Bed Recurrence Following Partial Nephrectomy in Patients with Small Renal Masses - Beyond the Abstract

Renal cell carcinoma (RCC) affects 64,000 people a year in the United States1. For select patients, partial nephrectomy has become the gold standard as a nephron-sparing alternative to radical nephrectomy2.  As the future of RCC is nonsurgical management options, Wood et al. wanted to further define what characteristics put patients at a higher risk for local tumor bed recurrence. 

Wood et al. evaluated the incidence, characteristics, and treatment of patients with tumor bed recurrence after undergoing partial nephrectomy. This study retrospectively reviewed 2,256 patients with sporadic small renal masses treated with partial nephrectomy between 2000 and 2014. The review found that local tumor bed recurrence is associated with male gender, a solitary kidney at partial nephrectomy, positive surgical margins, multiple tumors, and higher nephrometry score and pathological stage. 

This study compared 44 patients with local recurrence with 163 randomly selected patients who underwent partial nephrectomy with no recurrence in order to discern differences in multiple characteristics. For the purposes of this study, local tumor bed recurrence was defined as the detection of a new and enhancing lesion in the surgical bed of the original partial nephrectomy site(s) or in the same region of the ipsilateral kidney as the original partial nephrectomy site. This study found that local tumor bed recurrence occurs more frequently in patients with a solitary kidney (27% v 4%) and patients who presented with bilateral disease (23% v. 10.4%) compared to patients who did not experience recurrence. Additionally, 15.9% of patients with local tumor bed recurrences had positive margins, compared to only 3% of patients without recurrence. 

In conclusion, there are several factors that are associated with local tumor bed recurrence after partial nephrectomy. The results from this study could lead to the development of a scoring system that makes surgeons more aware of the risk of tumor recurrence faced by their patients. There are several limitations to this study, including the fact that it is retrospective and confined to a single institution. 

Written by: Zhamshid Okhunov, MD, University of California Irvine

References:
1. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin2014; 64:9-29.
2. Winer A, Zabor E, Vacchio M, Hakimi A, Russo P, Coleman J, Jaimes E. The effect of patient and surgical characteristics on renal function after partial nephrectomy. Clin Genitourin Cancer2017.


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