Laparoscopic Resection of Local Recurrence After Previous Radical Nephrectomy for Clinically Localized Renal-Cell Carcinoma: Perioperative Outcomes and Initial Observations

Yohannan, Jithin; Feng, Tom; Berkowitz, Jared; Connolly, Sheelah; Pierorazio, Philip; Allaf, Mohamad E.

doi:10.1089/end.2010.0051

Cited by 14 publications

(7 citation statements)

References 15 publications

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“…Previous studies have reported the feasibility of minimally invasive approaches with laparoscopic resection of RPR, however, the numbers in these series were extremely small. 18, 19 …”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Local Retroperitoneal Recurrence of Renal Cell Carcinoma after Radical Nephrectomy

et al. 2015

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Purpose Isolated local retroperitoneal recurrence (RPR) after radical nephrectomy (RN) for renal cell carcinoma (RCC) poses a therapeutic challenge. We investigated the outcomes of patients with localized RPR treated with surgical resection. Methods This was a retrospective single-institutional study of 102 patients with RPR treated with surgery from 1990-2014. Demographics, clinical and pathological features, location of RPR, perioperative complications were reported using descriptive statistics. Recurrence free survival (RFS) and cancer-specific survival (CSS) were studied using univariate and multivariate analyses. Results Median age at RPR diagnosis was 55 years (IQR 49-64). Sixty-two (60.8%) patients were pT3-4 and 20 (19.6%) were pN1. No patients had distant metastatic disease at time of RPR surgery. Median time from nephrectomy to RPR diagnosis was 19 months (IQR 5-38.8). The median size of resected RPR was 4.5cm (IQR 2.7-7). Median follow up after RPR surgery was 32 months (IQR 16-57). Metastatic progression was observed in 60 (58.8%) patients after RPR surgery. Neoadjuvant and salvage systemic therapy were administered in 46 (45.1%) and 48 (47.1%) patients, respectively. On multivariate analysis, pathological nodal stage at original nephrectomy and maximum diameter of RPR were identified as independent risk factors for cancer specific death. Conclusion Clinico-pathological factors at the time of nephrectomy as well as RPR surgery are important prognosticators. Aggressive surgical resection offers potential cure in a substantial number of patients with RPR with acceptable complications, and still plays a dominant role in the management of isolated locally recurrent RCC.

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“…Previous studies have reported the feasibility of minimally invasive approaches with laparoscopic resection of RPR, however, the numbers in these series were extremely small. 18, 19 …”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Local Retroperitoneal Recurrence of Renal Cell Carcinoma after Radical Nephrectomy

et al. 2015

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“…The authors suggested that selected patients with low-volume disease not involving adjacent organs should be offered laparoscopic resection. In another series consisting of 4 laparoscopic resections of localized recurrences, Yohannan et al 14 reported no open conversion in 4 patients, and only 1 intraoperative complication (diaphragmatic injury) occurred. The limited follow-up of this series (mean, 12 mo; range, 3 to 26) revealed no localized recurrence after surgery.…”

Section: Discussionmentioning

confidence: 97%

“…2–4,7–11 Recently, evidence regarding laparoscopic excision with or without the hand-assisted technique for local recurrence has been published by experienced centers. 12–14 In the present report, our experience with laparoscopic excision of local recurrence of RCC was examined in light of perioperative and oncological outcomes.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Excision of Local Recurrence of Renal Cell Carcinoma

Şanlı

Erdem

Tefik

et al. 2012

JSLS

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“…11 Reoperation after ipsilateral nephrectomy has been associated with significant morbidity in patients with renal fossa recurrence, 8 although a recent report demonstrated laparoscopic resection of RCC recurrence had low morbidity and minimal complications in four patients. 14 In patients with adrenal metastases after nephrectomy, open adrenalectomy necessitates a large incision to gain access for removal of a small gland. In addition to the possible benefits of less pain and a quicker recovery, patients may be able to return to systemic therapy for mRCC faster when using laparoscopic techniques compared with open surgery.…”

Section: Discussionmentioning

confidence: 99%

“…17 In the current series, the overall rate of complications is low and compares favorably with similar series. 14,18 The only complication in the reoperative group was one case of hemorrhage resulting in conversion to an open procedure and blood transfusion. The possibility of conversion to open surgery is a key aspect of preoperative patient counseling, because this risk may be higher than in patients without PIN.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Adrenalectomy for Metachronous Metastases After Ipsilateral Nephrectomy for Renal-Cell Carcinoma

Abel

Karam²,

Carrasco

et al. 2011

Journal of Endourology

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Background and Purpose: While laparoscopic adrenalectomy (LA) is considered the standard of care for removal of small adrenal masses, there are minimal data describing the feasibility and outcomes of LA after previous ipsilateral nephrectomy (PIN). The purpose of the study was to describe the perioperative outcomes in a series of patients who were undergoing LA after PIN. Patients and Methods: Using an institutional database, we identified patients who underwent LA since 2002 by a single surgeon. Clinical and pathologic data were collected and analyzed. To evaluate outcomes, patients undergoing LA after PIN were compared with patients undergoing LA without PIN. Results: Of 54 consecutive patients undergoing LA, 8 had PIN for renal-cell carcinoma (RCC). Estimated blood loss was not significantly greater in patients with PIN: 50 mL vs 100 mL, P = 0.109. Operative time was longer in patients with PIN: 120 minutes vs 156 minutes, P = 0.015. There was no difference in length of hospital stay between groups: Median 2 days for both groups, P = 0.635. One patient in the PIN group had a conversion to open adrenalectomy and needed blood transfusion. Perioperative complications were seen in 5/46 (10.6%) patients without and in 1/8 (12.5%) patients with PIN. Surgical margins were negative in all patients. Conclusions: To the authors' knowledge, this study represents the largest experience with adrenalectomy in the reoperative setting. LA after PIN is associated with a longer operative time. While the potential for conversion is possible, it is technically feasible in selected patients and thus far appears to be associated with similar perioperative outcomes compared with patients without PIN.

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Laparoscopic Resection of Local Recurrence After Previous Radical Nephrectomy for Clinically Localized Renal-Cell Carcinoma: Perioperative Outcomes and Initial Observations

Cited by 14 publications

References 15 publications

Surgical Management of Local Retroperitoneal Recurrence of Renal Cell Carcinoma after Radical Nephrectomy

Surgical Management of Local Retroperitoneal Recurrence of Renal Cell Carcinoma after Radical Nephrectomy

Laparoscopic Excision of Local Recurrence of Renal Cell Carcinoma

Laparoscopic Adrenalectomy for Metachronous Metastases After Ipsilateral Nephrectomy for Renal-Cell Carcinoma

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