When local recurrence occurs, management is particularly challenging. High-level evidence guiding salvage treatment is lacking, and no level 1 data are available to support the optimal use of repeat FT or redo-PN in this setting. Consequently, clinical decision-making relies largely on retrospective series and expert opinion.
Within this context, the current systematic review was completed, including 30 studies on 873 patients with RCC who underwent salvage treatment.1
Key Findings
- The major postoperative complication rates, defined as Clavien-Dindo ≥3, ranged from 2% to 9% for FTs and from 1% to 18% for PN.
- The rates of overall survival ranged from 82% to 100% for FTs, and from 96% to 100% for PNs.
- For recurrence after ablation, repeating the ablation is preferred. For recurrence after partial nephrectomy, robotic or traditional redo-PN is safe, though technically demanding.
The clinical heterogeneity (found within the studies included) underscores the inherent need for multidisciplinary discussion to identify the most appropriate treatment strategy for each patient. While PN appears to be associated with better survival outcomes, FT is generally linked to lower complication rates, highlighting the importance of balancing oncological control with perioperative morbidity.
Written by: Francesco Di Bello, MD, University of Naples Federico II, Naples, Italy, Fundaciò Puigvert, Barcelona, Spain
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