The blind spots in follow-up after nephrectomy or nephron-sparing surgery for localized renal cell carcinoma

Abstract

A more intensive FU the first 6 months after nephrectomy for T2-T4 and FU imaging ≥5 years after surgery for T1 tumors might improve early and asymptomatic detection of recurrent disease after nephrectomy for RCC.

Pathological T3a Upstaging of Clinical T1 Renal Cell Carcinoma: Outcomes According to Surgical Technique and Predictors of Upstaging

“…The TNM stage typically determines the treatment option, follow-up protocol, and prognosis [18, 19]. Clinical staging is typically performed using contrast-enhanced CT, although there is a risk of missing renal sinus fat invasion, perirenal fat invasion, or renal vein thrombosis during CT, which can lead to pT3a upstaging [9, 11, 20].…”

Risk‐adjusted proposal for >60 months follow up after surgical treatment of organ‐confined renal cell carcinoma according to life expectancy

“…16 These data are confirmed by van Oostenbrugge et al, who found a higher rate of late metastases for pT1 tumors, as compared with higher T stages, and consequently made a plea for a longer follow-up period for low-stage tumors. 18 A very recent study by Antonelli et al comprising 393 patients with pT1 tumors showed a recurrence rate of 4.6% after a median time of 12.3 years. Most of the recurrence could be treated surgically, therefore the authors postulated an indefinite time of follow up for patients with pT1 RCC using ultrasound and chest X-ray.…”

“…showed in their study that pT1 tumors and patients with bone metastases developed metastases later than other patients . These data are confirmed by van Oostenbrugge et al ., who found a higher rate of late metastases for pT1 tumors, as compared with higher T stages, and consequently made a plea for a longer follow‐up period for low‐stage tumors . A very recent study by Antonelli et al .…”

Canadian Urological Association guideline for followup of patients after treatment of non-metastatic renal cell carcinoma

“…The mean time to recurrence is 56 months and almost half of all recurrences are detected beyond 5 years following RN. 73,74 Among several series, the local recurrence for T1 lesions is approximately 2%. Local recurrence is more common for larger tumours following partial nephrectomy or tumour ablation compared to radical nephrectomy.…”

“…[73][74][75] Dabestani et al 75 reported 35% recurrence rate after mean followup duration of 5 years in a population-based study of patients with T2 disease who underwent RN or PN. Retrospective analysis of single institution with similar followup showed 16% of recurrence, diagnosed between 24 and 57 months after RN, and the lung was the main…”