OP3-08 SURGICAL OUTCOMES IN THE MANAGEMENT OF ISOLATED NODAL RECURRENCES: A MULTICENTER INTERNATIONAL RETROSPECTIVE COHORT

Abstract

You have accessJournal of UrologyOutstanding Posters: Oncology1 Apr 2014OP3-08 SURGICAL OUTCOMES IN THE MANAGEMENT OF ISOLATED NODAL RECURRENCES: A MULTICENTER INTERNATIONAL RETROSPECTIVE COHORT Christopher M. Russell, Wassim Kassouf, Patrick Espiritu, David D. Buethe, Michael Poch, Wade J. Sexton, Julio M. Powsang, Simon Tanguay, Armen Aprikian, Michael Hanzly, Thomas Schwaab, and Philippe Spiess Christopher M. RussellChristopher M. Russell More articles by this author , Wassim KassoufWassim Kassouf More articles by this author , Patrick EspirituPatrick Espiritu More articles by this author , David D. BuetheDavid D. Buethe More articles by this author , Michael PochMichael Poch More articles by this author , Wade J. SextonWade J. Sexton More articles by this author , Julio M. PowsangJulio M. Powsang More articles by this author , Simon TanguaySimon Tanguay More articles by this author , Armen AprikianArmen Aprikian More articles by this author , Michael HanzlyMichael Hanzly More articles by this author , Thomas SchwaabThomas Schwaab More articles by this author , and Philippe SpiessPhilippe Spiess More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2329AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES 10 - 24% of patients treated surgically for local renal cell carcinoma (RCC) will experience a post-surgical recurrence, which poses a therapeutic challenge as surgical resection represents the only potentially curative option. Isolated nodal recurrence represents a subset of locoregional recurrence, yet to be described in detail, which may demonstrate a unique disease course and response to surgical intervention. METHODS Upon IRB approval a retrospective chart review at three independent institutions, identified 36 patients surgically treated for isolated nodal recurrence of RCC between 1993 and 2012. Of those, 22 met inclusion criteria of pTanyNanyM0 disease at initial nephrectomy and pTanyN1M0 disease at time of recurrence. Clinical, pathological, and radiological characteristics were reviewed. Progression free survival (PFS) was estimated using the Kaplan-Meier method. RESULTS At diagnosis the median age was 57 years (range 10-76) years. Overall median time to primary recurrence following nephrectomy was 31.5 months. Median size of nodal recurrence by radiographic imaging was 2.6 cm (range 1.5-10.2). Following resection of isolated nodal recurrence, 10 patients (45%) developed a secondary recurrence at a median of 10.2 months (range 2.5-47.6), and 2 (9%) succumbed to their disease. Neither pathologic staging nor positive lymph node density correlated with increased risk of secondary recurrence. There were no recorded intraoperative complications, mean estimated blood loss was 325 mL (range 20-1250), and median length of stay was 5 days (range 2-16). Overall median PFS was 12.7 months, and was 24.8 months in T(1-2) tumors, 9.9 months in T3 tumors, 13.4 months in clear cell recurrences, and 17.6 months in non-clear cell recurrences. Median follow-up in our cohort was 22.3 months (range 12.5-45.7). CONCLUSIONS Surgical resection represents the best curative option for patients presenting with isolated retroperitoneal lymph node recurrence of RCC, and a durable PFS following surgery is attainable in many patients regardless of initial tumor stage or histology of recurrence. As such all patients free of precluding comorbidities should be considered for complete surgical resection by an experienced genitourinary surgeon. Also of note, despite similar survival statistics, tumors with a clinical stage ≥ T3 exhibited a general trend to develop secondary recurrence sooner than their T1 and T2 counterparts, suggesting that these patients may require more aggressive monitoring in the initial post-operative period. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e854 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Christopher M. Russell More articles by this author Wassim Kassouf More articles by this author Patrick Espiritu More articles by this author David D. Buethe More articles by this author Michael Poch More articles by this author Wade J. Sexton More articles by this author Julio M. Powsang More articles by this author Simon Tanguay More articles by this author Armen Aprikian More articles by this author Michael Hanzly More articles by this author Thomas Schwaab More articles by this author Philippe Spiess More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...