Laparoscopic resection of local recurrence after previous radical nephrectomy for clinically localized renal-cell carcinoma: Perioperative outcomes and initial observations

Background and Purpose: Local recurrence is rare after radical nephrectomy for clinically localized renal-cell carcinoma (RCC). Aggressive open surgical resection of isolated local recurrence has been shown to offer durable local control and potential improvement in cancer-specific survival. The objective of this study is to assess early outcomes on a select group of patients who underwent laparoscopic resection of isolated local recurrence after radical nephrectomy for clinically localized RCC. Patients and Methods: The perioperative and clinical outcomes of four patients who underwent laparoscopic resection of local recurrence between 2007 and 2009 by a single surgeon were reviewed. Results: Two patients underwent resection of ipsilateral adrenal recurrence while the remaining two underwent resection of recurrence in retroperitoneal lymph nodes. The mean age of patients was 57 years (44-66y), all had primary tumors with clear-cell histology, and Eastern Cooperative Oncology Group performance status was 0. The mean recurrence size was 5cm (3-7cm). All surgical margins were negative. Mean operative time was 195 minutes (170-210min), and mean estimated blood loss was 187mL (100-250mL). No patient needed blood transfusion. Mean length of stay was 2.5 days (2-3d). At a mean follow-up of 12 months (2-26mos), 1 patient experienced further recurrence. All patients are alive, and three have no evidence of disease. Conclusions: Aggressive surgical resection of isolated local recurrence of RCC after radical nephrectomy with curative intent may be beneficial and has traditionally been performed using open surgery. In our limited experience, a laparoscopic approach may be used in selected patients with small well-circumscribed recurrences with low morbidity and excellent short-term outcomes.