Presentation Authors: Paul Russo, Kyle Blum*, Robert Motzer, New York, NY
Introduction: Characterizing the timing and patterns of renal cell carcinoma (RCC) recurrence after nephrectomy is critical for patient counseling, developing surveillance protocols and selection of adjuvant therapies. Our institutional experience indicates that after 60 months, approximately 11% of patients undergoing open kidney surgery for localized renal cancer will recur with 1% of these at metastatic sites (PFS of >84%, Russo, Cancer 2008). In the last 15 years we have noticed a number of patients treated with minimally invasive surgery (MIS) for RCC who developed unusual patterns of tumor recurrence. Herein we describe the clinical characteristics and outcomes of these patients with atypical recurrences.
Methods: Patients managed at MSKCC with MIS radical or partial nephrectomy for localized (N0M0) RCC from 2003-2017 who developed atypical recurrences were identified. Atypical recurrences were defined either as early time to recurrence or an unusual intraabdominal site of recurrence. Recurrence free survival (RFS) distribution was calculated using Kaplan-Meier method. Timing and location of recurrences were described.
Results: Of 28 patients identified, 20 (71%) were male, 15 (53%) had clear cell histology, 11 (39%) were radical nephrectomies and 15 (53%) were robotic-assisted. Stage 1, 2 and 3 disease was present in 16 (57%), 3 (11%), and 9 (32%), respectively. 21 (75%) of the initial MIS procedures were performed at academic centers. 16 (57%) patients were initially Stage 1 but progressed to Stage 4 at a median of 9 months. Unusual sites of recurrence included: abdominal carcinomatosis (14%), soft tissue tumor implants (19%), adjacent organ implants including liver, large and small bowel, spleen, omentum (52%), and port-site (15%). Out of 28 patients, 22 (81%) had an additional burden of therapy in added surgical resections and/or systemic therapies. After a median follow up of 43.5 months, only 5 patients are alive without disease.
Conclusions: In this cohort of localized RCC patients treated with MIS, early recurrence of cancer coupled with unusual sites of intraperitoneal disease was observed. The study limitations include referral, selection and reporting biases. Nevertheless, further investigation into the etiology of these unusual patterns of recurrence after kidney cancer MIS is required.