Local recurrences after laparoscopic resections for renal parenchymal cancer

Abstract

Introduction . Renal cancer constitutes 2–3 % of all tumors of the human body. Annually worldwide renal cancer morbidity increases by 2 %, about 90 % of cases are localized in the parenchyma. Currently, treatment of localized forms of kidney cancer increasingly incorporates kidney-preserving technologies. The objective is to evaluate the rate and causes of local renal cancer recurrence after laparoscopic resections of the organ for treatment of localized renal parenchymal cancer. Materials and methods . Retrospective analysis of 459 laparoscopic resections performed between June of 2011 to May of 2017 at the R. M. Fronstein Urology Clinic of the I. M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia was performed. Results . Of 459 patients who underwent endoscopic surgical kidney resections with video, 399 patients were diagnosed with renal cancer during planned histological examination, among them 3 (0.75 %) patients had local recurrence. All patients were operated on with laparoscopic access, in 1 case the surgery was complicated by intraoperative bleeding which required conversion to nephrectomy. At the time of primary surgery, all patients with cancer recurrence were diagnosed with stage Т1b. Clear cell renal cell carcinoma was verified in all patients by morphological examination, and malignancy grade (nuclear differentiation) per the Furman grading system was 2 (in 2 patients) and 3 (in 1 patient). In 2 patients, local recurrence was diagnosed 6 months after the surgery, in 1 patient – 12 months after the surgery. One case of local recurrence in the area of previous resection was detected, in 1 case dissemination of the process through paranephric tissue (apart from local recurrence) was observed, and 1 case of recurrence in the bed of the removed kidney was diagnosed. All patients underwent repeat surgery in the clinic: 2 patients were operated on laparoscopically, 1 patient underwent open surgery. Conclusion. In our opinion, prevention of local recurrences requires careful selection of patients for laparoscopic kidney resections, especially if patients have stage Т1b or higher. Technically complicated resections for deep tumor invasion into the sinus, as well as for wide tumor base, are recommended for patients with invariable indications. Nephrectomy is preferable for relative indications for resection. In the preoperative period, the presence and thickness of tumor pseudocapsule must be evaluated, and multicenter localization should be ruled out. Good technical equipment for laparoscopic kidney resection and observation of oncological principles during surgery decrease renal cancer recurrence risk. During morphological verification of renal parenchymal tumors with high oncological potential for progression and in the presence of positive surgical margin and tumor pseudocapsule invasion, control spiral computer tomography of the abdominal organs with intravenous contrast should be performed in the first 3 months after the surgery.