MP41-18 PATHOGENESIS, FEATURES AND PROGNOSIS OF RENAL RELAPSE AFTER PARTIAL NEPHRECTOMY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy I1 Apr 2016MP41-18 PATHOGENESIS, FEATURES AND PROGNOSIS OF RENAL RELAPSE AFTER PARTIAL NEPHRECTOMY Alessandro Antonelli, Mario Sodano, Maria Furlan, Regina Tardanico, Simona Fisogni, Francesca Carobbio, Alberto Cozzoli, Tiziano Zanotelli, and Claudio Simeone Alessandro AntonelliAlessandro Antonelli More articles by this author , Mario SodanoMario Sodano More articles by this author , Maria FurlanMaria Furlan More articles by this author , Regina TardanicoRegina Tardanico More articles by this author , Simona FisogniSimona Fisogni More articles by this author , Francesca CarobbioFrancesca Carobbio More articles by this author , Alberto CozzoliAlberto Cozzoli More articles by this author , Tiziano ZanotelliTiziano Zanotelli More articles by this author , and Claudio SimeoneClaudio Simeone More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.185AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Partial nephrectomy (PN) is the standard for all T1 renal cell carcinoma (RCC), whenever technically feasible. With respect to radical nephrectomy, PN has the specific risk of local recurrence that is rare and poorly investigated. This study presents the results of the pathological review of a series of second surgeries for a renal neoplasm relapsed after PN, in order to elucidate the pathogenesis of this events METHODS The records and the specimens of 15 patients (out of 710 consecutive PN performed between 1983 and 2015, prevalence 3%) submitted to a salvage surgery for a renal relapse after PN for a non-familiar and non-hereditary RCC were fully reviewed. In all the cases RCC was localized at the time of first surgery; patients were systematically followed according to an institutional schedule; no other relapses were found at a whole-body re-staging before second surgery RESULTS The average latency of the relapse was 42 months (min 3, max 132 months). Second surgery was a radical nephrectomy in all the cases. Histological subtype was concordant in 14/15 cases; an upstaging was found in 7/15 cases (47%), an upgrading in 4/15 (26%). In 8/15 cases (53 %) the topographic position of the relapsing and primary tumors was the same: in those there was a minimal margin of resection at the first PN (median margin 1.6 mm, range 0-3 mm) and the cellularity of the relapsing tumor was strictly mixed with the granulomatous reaction due to the sutures of the first operation. In 7/15 cases the position of the first and second neoplasm were different and the site of the first tumor showed multiple granulomas without tumoral cellularity: in 4 cases the first tumor showed a microvascular embolization in the rim of healthy parenchyma removed and in the peritumoral fat, and the relapses were multifocal with a diffuse microvascular embolisation; in 2 cases the histology was consistent with a papillary RCC and the relapse was multifocal; in 1 case the histotype of primary and relapsing tumor were different. At a median follow up time of 42 months from the second surgery 7 patients died for RCC while 4 are alive with metastasis. CONCLUSIONS The renal relapse after PN can be due to an incomplete resection, to a newborn tumor from a primary one showing a pattern of aggressiveness or to a true multifocality. In the case of an incomplete resection or primary tumor with aggressive features, the event of the relapse leads to an adverse prognosis, in spite of a prompt salvage surgery. The follow up of patients with suspect incomplete resection of aggressive tumor should be more intensive © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e567 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Alessandro Antonelli More articles by this author Mario Sodano More articles by this author Maria Furlan More articles by this author Regina Tardanico More articles by this author Simona Fisogni More articles by this author Francesca Carobbio More articles by this author Alberto Cozzoli More articles by this author Tiziano Zanotelli More articles by this author Claudio Simeone More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...