Moderated Poster

Poster, Podium & Video Sessions

MP16-15: Natural history of surgically treated local recurrence after nephrectomy

Friday, May 12
1:00 PM - 3:00 PM
Location: BCEC: Room 253AB

Presentation Authors: Paolo Capogrosso*, Milan, Italy, Eric Barret, Igor Nunes-Silva, Rafael Sanchez-Salas, François Rozet, Paris, France, Alessandro Larcher, Ettore Di Trapani, Alberto Briganti, Andrea Salonia, Francesco Montorsi, Roberto Bertini, Umberto Capitanio, Milan, Italy, Xavier Cathelineau, Paris, France

Introduction: Local recurrence (LR) without distant metastases after renal cancer (RC) treatment is relatively rare. In this context, little is known regarding the natural history after salvage surgery for LR.

Methods: We conducted a retrospective analysis on a cohort of 62 consecutive patients presenting with local recurrence after primary surgical treatment for RC at two academic institutions. In 25 cases (40.3%), patients presenting concomitant visceral and/or bone metastases were excluded. LR was defined as the presence of a pathologically confirmed recurrence of RC in the soft/tissue renal fossa after radical (RN) or at the level of the resection bed after partial nephrectomy (PN), respectively. All patients were treated with the complete surgical resection of the LR. Kaplan-Meier analysis was applied to assess rates of systemic progression (SP; defined as the evidence of distant metastases during the follow-up), disease-free survival (DFS; defined as the absence of either distant or local recurrence) and cancer specific mortality (CSM) after surgical resection of LR

Results: Overall, 37 patients had exclusive LR (59.6%). Of those, 21 (55.6%) vs. 16 (44.4%) patients were diagnosed with an LR after RN vs. PN, respectively. Median [mean (Q1-Q3)] time to LR was 18 [29.9 (8-42)] months after RN/PN. At initial treatment (PN or RN), pathologic T stage (pT) was pT1, pT2, pT3 and pT4 in 14 (38.2%) 8 (18.9%), 14 (38.2%) and 1 (2.9%) patients. Fuhrman grade resulted low (1-2) vs. high (3-4) in 21 (59.4%) vs. 16 (40.7%) patients.
At LR diagnosis, 28 (75.7%) patients were treated with LR resection only, while 9 (24.3%) received also systemic targeted therapy after LR resection. At 1 and 3 years after LR surgery, SP rates were 20% and 45% vs. 7% and 23% in RN vs. PN cases, respectively. Overall, at 1, 3 and 5 years after LR surgery, DFS was 93%, 85% and 67%. CSM resulted 10%, 20% and 25%, respectively. There was no significant difference in terms of SP, DFS and CSM between patients surgically treated for LR after RN or PN (all p>0.05).

Conclusions: Despite a surgical treatment of LR after either PN or RN, a systemic progression can be expected. However, given the encouraging results in terms of DFS and CSM, such management could be justified in clinical practice.

Source Of Funding: none

Paolo Capogrosso, MD

University Vita-Salute San Raffaele

Paolo Capogrosso M.D.
Division of Experimental Oncology/Unit of Urology;
URI; IRCCS Ospedale San Raffaele
Università Vita-Salute San Raffaele, Milan, Italy

EDUCATION AND TRAINING:
- From 2005 to 2011: Medical School; University Vita-Salute San Raffaele. Milan, Italy
- From 2012 until now: Residency programme in Urology; San Raffaele Hospital, Deparment of Urology; University Vita-Salute San Raffaele. Milan, Italy
- From October 2015 to December 2015: Clinical Fellowship in Laparoscopic Surgery of the Belgian Laparoscopic Urological Group.
Director: Dr Renaud Bollens. Centre hospitalier Wallonie Picarde, Tournai, Belgium; Centre hospitalier Epicura, Hornu, Belgium; Hopital St Phillibert, Lille, France
- From January 2016 to July 2016: Clinical Fellowship in Robotic and Laparoscopic surgery.
Institute Mutualiste Montsouris, Paris, France; Director: Prof X. Cathelineau
-From April 2017 until now: Research Fellowship in urology; Memorial Sloan Kettering Cancer Center. New York, US

CURRENT POSITION:
Resident in Urology
University: Vita-Salute San Raffaele
Ospedale San Raffaele, Milan, Italy


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