Surgical Outcomes in the Management of Isolated Nodal Recurrences: A Multicenter International Retrospective Cohort.

Journal of Urology (White)

PubMedID: 24530987

Russell CM, Espiritu PN, Kassouf W, Schwaab T, Buethe DD, Dhilon J, Sexton WJ, Poch M, Powsang JM, Tanguay S, Nayan M, Alsaadi H, Hanzly MI, Spiess PE. Surgical Outcomes in the Management of Isolated Nodal Recurrences: A Multicenter International Retrospective Cohort. J Urol. 2014;192(2):350-6.
PURPOSE
We report a multicenter international cohort representing the largest surgical experience in the management of isolated retroperitoneal nodal recurrences of renal cell carcinoma (RCC), a unique subset of locoregional disease, yet to be described in detail.

MATERIALS AND METHODS
Patients with isolated nodal recurrence of pTanyN+M0 disease following nephrectomy were identified through retrospective chart review at three independent institutions. Progression free survival (PFS), estimated using the Kaplan-Meier method, was utilized to compare survival outcomes between primary T(1-2)N(any)M0 and T3N(any)M0 tumors, as well as clear cell and non-clear cell histology RCC's.

RESULTS
A total of 22 patients met inclusion criteria. Median time to local post-nephrectomy recurrence was 31.5 months (IQR 12.9-43.3). Following resection of isolated nodal recurrence, 10 patients (46%) developed a secondary recurrence at a median of 11.2 months (IQR 8.1-18.4), and of those 2 (9%) succumbed to their disease. Overall median PFS was 12.7 months, and was 24.8 months in T(1-2)N(any)M0 tumors, 9.9 months in T3N(any)M0 tumors, 13.4 months in clear cell RCC's, and 17.6 months in non-clear cell RCC's.

CONCLUSION
Surgical resection represents the best curative option for patients presenting with isolated retroperitoneal lymph node recurrence of RCC, and a durable PFS following surgery is attainable in many patients regardless of histology or clinical TNM staging. In addition, our cohort demonstrated a lower RCC related mortality rate than previously reported series of local metastasis. As such, all patients free of precluding comorbidities should be considered for complete surgical resection by an experienced genitourinary surgeon.