The purpose of the study was to investigate the frequency and causes of local recurrences of renal tumors after organ-saving surgery, to evaluate the results of surgical treatment of patients with local recurrence, to investigate long-term results of treatment of patients with recurrent tumors, and to evaluate the prognostic value of tumor characteristics for the development of recurrence. Material and methods. We examined 31 patients with local recurrence of renal tumor after organ-saving surgery, 13 (41.9%) of them were performed organ-saving surgery in other regions of Ukraine. The prognostic value of tumor characteristics for the development of recurrence and the frequency of recurrences were evaluated taking into account the results of further observation of 701 patients after organ-saving surgery of kidney tumors. Results and discussion. The causes of local recurrence of renal tumors were analyzed by comparing CT data before primary surgery and after recurrence, as well as pathomorphologic examination of removed tissues after repeated operations. As a result, recurrence was found in the area of resection of the neoplasm. That is why, we concluded that the recurrence was the most likely associated with inadequate tumor removal which happened in 21 (67.7%) cases. Local recurrences associated with multifocal tumor were found in 7 (22.6%) patients. Recurrent tumors were localized in the resection zone and other parts of the kidney (multifocal + recurrence in the resection zone) in 2 (6.5 %) cases. In total, local recurrence was combined with lymph node metastases in 3 (9.7%) cases. There was a multifocal tumor with lymph node metastases in 2 (6.5 %) patients and a recurrent lymph node metastasis in the resection zone in 1 (3.2 %) patient. There was the recurrent tumor spread to the venous system in 8 (25.8 %) cases. Intrarenal vein invasion was detected in 4 (12.9%) cases. Invasion into the main renal vein was recorded in 2 (6.5%) patients. The recurrence of tumor with invasion into the inferior vena cava after organ-saving surgery was detected in 2 (6.5%) patients: in 1 (3.2%) with spread to the subhepatic division of the inferior vena cava and in 1 (3.2%) to the intrapericardial department of the inferior vena cava. Our study showed that the overall rate of progression after organ-saving surgery was 4.95 % (death from kidney cancer + metastases + local recurrence). These data were obtained from follow-up of 606 patients after surgery, with an average of 45±2.1 months. At the same time, the incidence of isolated local recurrence for the entire cohort of our patients was 1.5%, which is quite low. Although the number of relapses undoubtedly depends on the level of tumor complexity for organ-saving surgery and in our cases the incidence ranged from 0 % to 16.7 % depending on the characteristic of the tumor. Conclusion. It is obvious that the incidence of recurrence of the disease is directly proportional to the complexity of the tumor that is subject to organ-saving surgery. According to our data, reliable prognostic criteria for an increased risk of local recurrence were the following: the tumor size >7 cm, the presence of intravenous invasion and repeated organ-saving surgery at relapse. Although criteria such as: multifocal tumor, intra-parenchymal localization, and the presence of imperative indications for organ-saving surgery were also characteristic for patients with more local recurrences, but the reliability of their effect was not achieved. However, it is undeniable that these tumor characteristics have a significant effect on long-term cancer outcomes.
Full text: PDF (Ukr) 211K