Abstract
In this timely review article, Skolarikos et al [1] provide an in-depth summary of issues pertaining to surveillance for disease recurrence following nephrectomy for patients with localized renal cell carcinoma (RCC). The reviewed topic is of paramount importance for the urologic community because it is estimated that 30% of patients undergoing nephrectomy for presumed localized disease eventually experience recurrence. Furthermore, there is still uncertainty regarding the optimum approach to detect recurrence early. Based on a comprehensive analysis of the relevant literature, the authors discuss the rationale for surveillance and the timing, intensity, duration, and methods of surveillance appropriate for various patient groupings. The authors emphasize that, at the present time, no prospective or randomized studies have been conducted to address these important questions. All currently available recommendations on surveillance are based on retrospective, mostly single-center studies achieving a maximum evidence level of only III/B. However, until the time that high-level evidence becomes available (and there are currently no plans for prospective studies to evaluate this question of which we are aware), patients must be followed using the best data available. In the distant past, the majority of clinicians followed all patients according to the same general plan, regardless of tumor histology, tumor stage, tumor grade, or other factors of tumor biology that drive the risk of tumor recurrence. At the present time, the most widespread surveillance strategies are based on stage-based protocols [2] because tumor stage is the most important predictor for recurrence after nephrectomy, allowing the intensity and duration of surveillance strategies to be tailored according to the tumor’s stage. However, in the last few
Published Version
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