Systematic Review of the Management of Local Kidney Cancer Relapse.

Management of locally recurrent renal cancer is complex.

In this systematic review we analyse the available literature on the management of local renal cancer recurrence.

A systematic search (PubMed, Web of Science, CINAHL, Clinical Trials, and Scopus) of English literature from 2000 to 2017 was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.

The search identified 1838 articles. Of those, 36 were included in the evidence synthesis. The majority of the studies identified were retrospective and not controlled. Local recurrence after thermal ablation (TA) may be managed with repeat TA. Alternatively, salvage nephrectomy is possible. However, a higher rate of complications should be expected than after primary nephrectomy. Salvage nephrectomy and TA represent treatment options for local recurrence after partial nephrectomy. Local retroperitoneal recurrence after radical nephrectomy is ideally treated with surgical resection, for which minimally invasive approaches might be applicable to select patients. For large recurrences, addition of intraoperative radiation may improve local control. Local tumour destruction appears to be more beneficial than systemic therapy alone for local recurrences.

Management of local renal cancer relapse varies according to the clinical course and prior treatments. The available data are mainly limited to noncontrolled retrospective series. After nephron-sparing treatment, TA represents an effective treatment with low morbidity. For local recurrence after radical nephrectomy, the low-level evidence available suggests superiority of surgical excision relative to systemic therapy or best supportive care. As a consequence, surgery should be prioritised when feasible and applicable.

In renal cell cancer, the occurrence and management of local recurrence depend on the initial treatment. This cancer is a disease with a highly variable clinical course. After initial organ-sparing treatment, thermal ablation offers good cancer control and low rates of complications. For recurrence after radical nephrectomy, surgical excision seems to provide the best long-term cancer control and it is superior to medical therapy alone.

European urology oncology. 2018 Jul 13 [Epub]

Maximilian C Kriegmair, Riccardo Bertolo, Pierre I Karakiewicz, Bradley C Leibovich, Borje Ljungberg, Maria C Mir, Idir Ouzaid, Maciej Salagierski, Michael Staehler, Hendrik van Poppel, Christopher C Wood, Umberto Capitanio, Young Academic Urologists Kidney Cancer working group of the European Association of Urology

Department of Urology, University Medical Centre Mannheim, Mannheim, Germany. Electronic address: ., Glickman Urological and Kidney Institute, Department of Urology, Cleveland Clinic, Cleveland, OH, USA., Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Canada., Department of Urology, Mayo Clinic, Rochester, MN, USA., Department of Surgical and Perioperative Science, Urology and Andrology, Umeå University, Umeå, Sweden., Department of Urology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain., Department of Urology, Bichat Hospital, APHP, Paris Diderot University, Paris, France., Urology Department, Faculty of Medicine and Health Science, University of Zielona Gora, Zielona Gora, Poland., Department of Urology, Ludwig-Maximilians University, Munich, Germany., Department of Urology, University Hospitals Leuven, Leuven, Belgium., Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Department of Urology, San Raffaele Scientific Institute, Milan, Italy; Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy.