Laparoscopy viable for local RCC relapse
medwireNews: Laparoscopic treatment of local relapse of renal cell carcinoma (RCC) is a viable alternative to open surgery in selected cases, study findings show.
"It allows faster recovery with less bleeding and fewer complications than open surgery when performed by experienced laparoscopists," say Albert El Hajj (Paris Saint Joseph Hospital Trust, France) and colleagues.
Local relapse of RCC following radical nephrectomy is rare, the researchers point out in BJU International, but surgical removal is the only opportunity for cure.
They assessed the feasibility of laparoscopic removal of local recurrence in seven men and two women, aged an average of 67 years, who had relapsed with clear cell carcinoma a mean 83 months after nephrectomy.
Three patients received neoadjuvant treatment prior to surgery, while a further two received adjuvant therapy.
The recurrent tumor size varied from 2.5 to 4.5 cm, the average operation duration was 144 minutes, the mean estimated blood loss was 430 mL, and the average hospital stay was 4.5 days.
Pathology confirmed that the pure laparoscopic approach with wide excision of surrounding tissue allowed negative margins in all patients and none of the patients required conversion to open surgery.
Complications occurred in four patients overall, with three Clavien grade I intraoperative complications, and two late complications of Clavien grade I and IIIb.
Over a mean follow-up period of 3 years, 67% of patients remained free of disease, and the cancer-specific survival rate was 89%.
The researchers note that while the laparoscopic technique was effective, "patients with multiple locations are not ideal candidates for this approach as they present with a higher complications rate and may require additional extirpative surgery."
They add: "Individualizing the laparoscopic approach was also found to be an important factor in our technique; it allowed better access to the tumour and thus satisfactory oncological results.
"It also led to a faster postoperative recovery time, with shorter hospital stay and less postoperative morbidity."
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013
By Lucy Piper, Senior medwireNews Reporter