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PubMed1987

Recurrent carotid stenosis: operative strategy and late results.

From 1957 to 1985, 116 consecutive operations for recurrent carotid stenosis were performed in 99 patients at the University of California, San Francisco. Ninety-four patients underwent 103 reoperations for primary recurrent stenosis (nine patients had bilateral repairs). Seventy-two operations (70%) were performed to relieve cerebrovascular symptoms whereas the indication for 31 operations (30%) was high-grade stenosis. The cause of primary recurrent stenosis was myointimal hyperplasia (MIH) in 47 cases, whereas 56 were caused by recurrent atherosclerosis (ASO). Secondary recurrent stenosis developed in six patients from our own series (5.8%) and an additional six patients were referred after reoperation elsewhere. The 12 lesions in this group were evenly divided between MIH (six) and recurrent ASO (six). MIH resulted in a single tertiary recurrent stenosis. Myointimectomy or repeat endarterectomy and vein patch angioplasty were the most commonly used techniques for repair of a primary recurrent stenosis. Secondary recurrent stenosis necessitated resection of the carotid bifurcation and graft interposition when caused by MIH. Secondary recurrent stenosis caused by ASO could be treated by repeat endarterectomy and vein patch angioplasty in five of six cases. Five strokes occurred in the entire series (4.3%), resulting in two deaths. There were 23 cranial nerve palsies, which rarely persisted beyond 3 months. The morbidity and mortality rates for primary and secondary carotid reoperation are comparable to the original procedure and should not deter the vascular surgeon from reoperative carotid reconstruction whenever indicated.

Blood Vessel Prosthesis↗

PubMed1987

Clinical patterns of tumor recurrence after radical hysterectomy in stage IB cervical carcinoma.

We reviewed the cases of 31 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB cervical carcinoma who developed recurrent disease after radical hysterectomy and pelvic lymphadenectomy between 1961 and 1982. The overall incidence of recurrence was 11.3%. Recurrence was significantly more common in patients with adenocarcinoma or adenosquamous carcinoma (17.4%) than in those with pure squamous tumors (9.2%). The median time from operation to recurrence was eight months. The median survival of patients dying of disease was 18 months. Sites of recurrence were categorized as central pelvic in 35% of cases, pelvic sidewall in 39%, and distant in 26%. Patients treated with postoperative pelvic radiotherapy for positive pelvic nodes or surgical margin involvement were more likely to develop distant recurrence. Various therapeutic modalities were used to treat recurrent disease. Twenty-two of 23 patients with central pelvic or sidewall recurrence failed radiation therapy. None of four patients with central recurrence treated by pelvic exenteration survived. No patient treated with chemotherapy survived. Overall survival for patients with recurrence was 3.2%. The dismal prognosis for this group of patients warrants evaluation of alternative treatment modalities.

Adenocarcinoma↗

PubMed1985

[Clinicopathological features of recurrent breast cancer].

Recurrence of breast cancer is classified into three categories, namely local (chest wall) recurrence, recurrence in regional lymph nodes, and distant metastasis. In an analysis of 77 recurrent cases out of 385 breast cancer cases managed by us from 1962 to 1973, recurrence of the former two categories occurred early, mostly within three years, but distant metastatic disease occurred in later years. With regard to staging and the time of recurrence, it was observed in general that the earlier the initial stage of disease, the longer the time period until the presence of detectable recurrence. In addition, as to local recurrence and distant metastases in various sites, the following aspects were reviewed and discussed; incidence, mechanisms of recurrence, characteristics of the recurrent disease.

Bone Neoplasms↗

PubMed1984

[Incidence of lithiasic recurrence after a diuretic therapy, alone or combined with treatment by a thiazide diuretic or phosphorus].

The preventive affects on recurrent renal calcium stones of water diuresis alone or combined with drugs aimed at lowering urinary calcium were evaluated prospectively in 51 patients with calcium nephrolithiasis. Following clinical and metabolic examination, the patients were allocated at random to 3 treatment groups: water diuresis alone (group I, n = 19) or associated with hydrochlorothiazide 50 mg/day (group II, n = 19) or with a neutral phosphate preparation 1500 mg/day (group III, n = 13). Results were assessed on the number of recurrences; 24-h urinary calcium was measured at regular intervals. The mean follow-up (2 years; range 1-4 years) was the same in all 3 groups. A significant fall in recurrence rate as compared with pre-treatment values was observed in groups I and II. The recurrence rate was the same in both groups during treatment. However, less patients had recurrences in group I (1/19) than in group II (5/19). No significant fall in recurrence rate was observed in group III, owing to some patients in this group having frequent recurrences. The recurrence rate was unrelated to clinical findings and biochemical values ( oxaluria , calciuria) measured before treatment and to the urinary Ca/Cr ratio calculated during treatment. This study confirms that water diuresis is effective in preventing recurrent renal calcium stones and that diuretics of the thiazide group reduce the number of patients with recurrences.

Adult↗

PubMed1980

Hyperthermic perfusion of recurrent malignant melanoma on the extremities.

Twenty-one patients with recurrent malignant melanoma on the extremities were treated by regional hyperthermic perfusion with melphalan (Alkeran). Four patients had a second perfusion. The recurrence site was on the foot in one patient, on the lower part of the leg in 13 patients, below the mid-thigh in 6 patients and on the elbow in one patient. The temperature of the extremities was registered continuously during the perfusion. Perfusion was performed under hyperthermic conditions with a temperature of 40-41.0 degrees C i.m. The perfusion time was 2 hours. Alkeran was given in a dose of 0.9 mg/kg bodyweight for lower extremity perfusion and 0.45 mg/kg for upper extremity perfusion. Complete tumour regression or more than 50% tumour regression was registered in 8 out of the 10 patients with manifest tumour. As the first sign of recurrence after perfusion, 4 patients had local recurrence and 10 had systemic recurrence. Altogether one-third of the patients had local recurrences and half of the patients systemic recurrences. Local recurrences occurred after a median time of 8 months and systemic recurrences after a median time of 7 months. Nine patients are still alive after an observation time of 5.5 months to 44 months. Three patients are without any signs of recurrent disease.

Aged↗

PubMed1995

Local treatment of malignant gliomas by direct infusion of specific monoclonal antibodies labeled with 131I: comparison of the results obtained in recurrent and newly diagnosed tumors.

Two murine monoclonal antibodies, BC-2 and BC-4, raised against tenascin and labeled with 131I were infused locally in the site of neoplastic disease by means of a removable (16 patients) or indwelling (34 patients) catheter. Fifty patients bearing a malignant glioma were treated. Twenty-six of these were suffering from recurrent disease; their tumors relapsed within 9 months (median) after treatment. The remaining 24 cases had a newly diagnosed tumor, and local radioimmunotherapy (RIT) was given immediately after surgery and radiochemotherapy. All efforts were made to reduce the tumor before the infusion of the radiopharmaceutical. Therefore, 22 cases with relapsing glioma underwent additional debulking surgery, which led to total or subtotal removal of tumor in 9 of the patients. Altogether, 28 patients had intralesional RIT when the disease was minimal or microscopic. Conversely, 22 cases underwent local RIT with a tumor the diameter of which was > 2 cm. In many cases, the infusions were repeated up to six times to achieve complete destruction of the neoplastic tissue. The local treatment did not give rise to systemic or to cerebral adverse effects. The labeled monoclonal antibodies, given directly in the site of the lesion, concentrated in very high amount in the neoplastic tissue and remained fixed in the target for a long period of time. For these reasons, the radiation dose to the tumor was remarkable (on average > 30,000 cGy/cycle) and consequently led to promising results. The median survival was, in total, 20 months (18 in recurrent tumors and 23 in newly diagnosed lesions). Moreover, median survival was 17 months in patients with bulky tumors (both recurrent and newly diagnosed tumors) and 26 months in patients with minimal or microscopic disease. The median time to progression was 3 months in recurrent and 7 months in newly diagnosed gliomas. Finally, RIT produced 3 CRs (all in recurrent tumors), 6 PRs (4 in recurrent and 2 in newly diagnosed), and 11 stabilizations of disease (4 in recurrent and 7 in newly diagnosed). In 19 cases (13 recurrent and 6 newly diagnosed) the progression of tumor was recorded. Eleven patients (2 recurrent and 9 newly diagnosed) who were treated by RIT when their disease was minimal and nondetectable by radiological methods remained disease-free and were classified as NED. The overall response rate (NED plus CR plus PR) was 40% (34.6% recurrent and 45.8% newly diagnosed).(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1994

Incidence and risk factors of recurrent episodes of bacteremia in adults.

BACKGROUND: Bacteremia is a cause of high morbidity and mortality. Recurrent episodes of bacteremia, its risk factors and characteristics, have been poorly evaluated in the literature, although its occurrence has been established. PATIENTS AND METHODS: Analysis of 1426 patients who presented with 1579 episodes of bacteremia and who were prospectively evaluated in a university-affiliated hospital during a 48-month period. The risk factors for a patient to develop a recurrence of bacteremia was assessed comparing those with recurrent episodes with those who survived an episode of bacteremia with no recurrence during the follow-up period. RESULTS: A total of 105 patients presented with 248 episodes of bacteremia, of which 143 episodes were recurrent (recurrence rate, 9% of all bacteremic episodes). Two factors were independently predictive of recurrent bacteremia: (1) the presence of an underlying disease (especially a rapidly fatal one [odds ratio, 7.27]) or (2) any complication during the initial episode of bacteremia. Using these factors, the prediction model was significant, but misclassification was high, with a sensitivity of 61% and a specificity of 67% for a cutoff point that maximized both factors. CONCLUSIONS: We identified risk factors for patients who presented with an initial episode of bacteremia to develop a recurrence rate. The recurrence risk factors may be used as a form of guidance for extreme preventive measures, but these factors could not predict recurrence with a high degree of accuracy.

Bacteremia↗

PubMed1993

Early detection of lymphoma recurrence with gallium-67 scintigraphy.

Early detection of tumor relapse in lymphoma patients is often a difficult diagnostic problem. CT, which detects a mass, often cannot differentiate between fibrosis or relapsed tumor. For this reason, we have studied the value of 67Ga scintigraphy in the diagnosis of tumor recurrence. The sensitivity of 67Ga scintigraphy in the detection of lymphoma recurrence was studied at an average interval of 8.7 mo following treatment in 32 patients who developed recurrent lymphoma. Its specificity was studied in 36 patients with no recurrence who were in continuous clinical remission. At the time of appearance of relapse, the sensitivity of whole-body 67Ga imaging was 95% and the specificity 89%. In 12 events of recurrence in 10 patients, 67Ga scintigraphy was abnormal at sites that later proved to be regions of relapse. In these patients, scintigraphy demonstrated recurrence an average of 6.8 mo before the appearance of clinical symptoms, findings on clinical examination or abnormality on CT or chest x-rays. Gallium-67 scintigraphy, which permits screening of the whole body for recurrence in a single study, was of particular value in evaluating lymphoma recurrence, since 27% of the recurrences were located exclusively in sites different from the original sites of disease. Gallium-67 scintigraphy appears to be a sensitive and specific test for restaging patients with lymphoma recurrence.

Adolescent↗

PubMed1993

[Surgical treatment of recurrent thyroid carcinoma after primary resection].

Twenty-six patients who underwent the second operation for recurrent thyroid carcinoma were reviewed. 1) Three surgical interventions; dissection of local lymph nodes, modified neck dissection and extended neck dissection, for the patients with recurrent thyroid carcinoma were performed. Among these patients, recurrence of thyroid carcinoma occurred again in 14 (74%) of 19 patients with dissection of local lymph nodes, 15 (63%) of 24 with modified neck dissection, 2 (22%) of 9 with extended neck dissection. Patients with extended neck dissection had significantly less local recurrence than those with other procedures (p < 0.05). 2) Lymph node recurrence on the resected area occurred in 11 (73%) of 14 patients with dissection of local lymph nodes. Ten (67%) of 15 patients with modified neck dissection had recurrence beyond the dissected area. 3) In well differentiated carcinoma, there was recurrence in 5 (62%) of 8 patients with dissection of local lymph nodes, and in 4 (31%) of 13 with modified neck dissection. In contrast, in poorly differentiated carcinoma, we found recurrence in 8 (89%) of 9, and 10 (100%) of 10, respectively. However, in only one (20%) patient with extended neck dissection, recurrence occurred. We conclude that extended neck dissection should be the procedure of choice in patients with recurrent thyroid cancer whenever feasible.

Aged↗

PubMedDate not supplied

[Analysis of the factors associated with recurrence of post-thyroidectomy goiter].

The factors associated with post-thyroidectomy goiter recurrence in benign thyroid disease are not clearly defined, especially prophylactic thyroxine treatment. PURPOSE--To determine the prevalence, characteristics and associated factors of recurrence of goiter post-thyroidectomy in patients submitted to surgery for benign disease. METHODS--Sixty-six patients, 53 female and 13 male (mean age = 51 yrs., range 20-82 yrs.), previously (5.6 +/- 6.1 yrs.) submitted to thyroidectomy (lobectomy, n = 50; nodulectomy, n = 5; subtotal thyroidectomy, n = 11) for benign thyroid disease were included. Measurements of T3, T4, TSH, thyroid microsomal autoantibody titers and thyroid ultrasonography were performed at the time of the study. Recurrence of goiter post-thyroidectomy was defined on ultrasonography as the presence of residual thyroid volume > 20mL and/or new nodules > 0.5mL not detected at surgery. RESULTS--Seven patients (10%) developed recurrence of goiter. The post-operative follow-up period was longer in the recurrence group and there was no difference between the two groups as to age, sex, familial history of thyropathy and preoperative goiter diagnosis. In multiple regression analysis only the following post-operative period was significantly associated to goiter recurrence (beta = 0.02; R2 = 0.16; p < 0.05) and influenced the goiter recurrence rate by 14%. Familial history of thyropathy, thyroxine treatment in non-supressible doses after thyroidectomy and seric T4 and TSH levels did not influence the recurrence. CONCLUSION--Recurrence of goiter post-thyroidectomy occurs in a small number of patients and is related to longer post-operative follow-up time. Thyroxine treatment in non-supressible doses after surgery is not related to goiter recurrence prevention.

Adult↗

PubMed1995

[Local recurrence following breast-conserving treatment for breast carcinoma; treatment and prognosis in 82 patients].

OBJECTIVE: To evaluate the treatment and prognosis of 82 patients with local relapse in the breast as the first event after breast-conserving therapy of operable breast cancer. DESIGN: Descriptive and retrospective. SETTING: 17 general hospitals in southeast North-Brabant and North-Limburg. METHODS: Using the registries of the Comprehensive Cancer Centre South in Eindhoven (1981-1990) and the Bernard Verbeeten Institute in Tilburg (1981-1987), 82 patients were identified who had developed local recurrence after breast-conserving therapy. RESULTS: The mean age of the 82 patients at the time of detection of local recurrence was 51 years. 46 recurrences (56%) were localized at or near the site of the original tumour, 14 (17%) were detected elsewhere in the breast, 15 (18%) showed diffuse spread through the breast and seven (9%) were completely or partly localized in the skin. Nine recurrences (11%) were non-invasive. Of the 82 patients four received adjuvant systemic therapy only and no surgery. Of the 78 patients treated with surgery 72 underwent mastectomy, 6 local excision. After treatment, the actuarial five-year overall survival, distant recurrence-free survival and disease-free survival rates were 60%, 43% and 31% respectively. Local control, defined as survival without second local recurrence and without local progression of the disease, was 57% after five years. CONCLUSION: The five-year distant recurrence-free and disease-free survival rates for patients with local recurrence after breast conserving-therapy were low. The high proportion of second local recurrences and local progression of disease in this study underlines the difficulty of obtaining local control after treatment of local recurrence.

Adult↗

PubMed1996

Correlation between early recurrence and reoperation after ileocolonic resection in Crohn's disease: a prospective study.

BACKGROUND: The medical and surgical treatment of patients with Crohn's disease is directed at reducing symptoms and postponing recurrence. In the determination of high-risk groups for surgical recurrence after ileocolonic resection, the role of early endoscopic evaluation is unclear. STUDY DESIGN: We investigated the relationship between early recurrence detected endoscopically and recurrence detected by operation in a prospective study of 60 patients, who underwent ileocolonic resection for Crohn's disease. RESULTS: Recurrence detected endoscopically was found in 44 patients (73 percent) according to definition I (presence of any lesion detected endoscopically that was compatible with Crohn's disease) and in 21 patients (35 percent) according to definition II (five or more aphthous lesions present in the neoterminal ileum or at the anastomotic site, or 25 percent or more of the intestinal circumference inflamed). Recurrence detected surgically was found in 14 patients (23 percent). No correlation between early recurrence detected endoscopically and recurrence detected surgically was evident. CONCLUSIONS: Early recurrence detected endoscopically did not predict recurrence detected surgically.

Adolescent↗

PubMed1996

[Preperitoneal prosthesis implantation in surgical management of recurrent inguinal hernia. Retrospective evaluation of our results 1989-1994].

Recurrent inguinal hernia represents a great problem in surgery given the frequency of this operation, with a recurrence rate of 0.5-8%. Re-recurrence after repair without implantation of a prosthesis occurs in 1-23% of cases. We analyzed our results of patients with recurrent inguinal hernia, operated according to the method of Stoppa. Between 1989 and July 1994 there were 58 operations upon 55 patients with an average age of 65 years, 79% of whom had unilateral and 21% bilateral hernias. 89% of all patients underwent surgery because of a recurrent inguinal hernia. A Marlex mesh was used in 79% of the case. All patients were followed up (mean 35 months, minimum 12 months). Early complications consisted in one hematoma (1.7%), which had to be drained, as well as one early recurrence (1.7%). No infections were observed. The overall recurrence rate was 12%. However, 60% of all recurrences occurred in the few first years after introduction of this technique at our clinic; with growing number of operations and experience with Stoppa's technique, we obtained a recurrence rate of 6-7% per year. In our opinion, supported by the results of other studies, Stoppa's technique is a successful method in the treatment of recurrent inguinal hernia.

Adult↗

PubMed1996

[A clinical study of recurrent breast cancer].

In a recent 14-year period from December 1978 to December 1993, 180 patients with breast cancer were treated at the hospital, and out of these 180 patients, 38 patients (21.1%) who had a recurrent breast cancer were clinically evaluated. The first recurrence occurred in the local skin in 13 patients, regional lymph node in 1, bone in 13, lung in 4, liver in 4 and in other areas in 3. Histologically, the incidence of scirrhous carcinoma recurrence was higher than that of papillotubular carcinomas. There was no recurrence in mucinous carcinomas. The frequency of recurrence became higher in accordance with TNM classification, namely, 6.7% in Stage I, 23.7% in Stage II, 37.5% in Stage IIIa, and 47.1% in Stage IIIb cancers. An increasing tendency in the recurrence rate was also noted with an increase of tumor diameter or lymph node metastasis. Otherwise, there was no difference in cumulative survival after recurrence between TNM classification. There were no correlations between the estrogen receptor and incidence of recurrence or 5-year survival rate. The disease free interval (DFI) was less than 2 years in about 60% of the recurrent cases. DFI of bone metastasis was longer than for the other sites of recurrence. The survival rate increased according to prolongation of DFI. After through evaluation of these results, one should pay close attention to follow-up after mastectomy.

Adult↗

PubMed1996

The significance of hypofibrinolysis for the risk of recurrence of venous thromboembolism. Duration of Anticoagulation (DURAC) Trial Study Group.

An impaired fibrinolytic function has been described in several case-control studies of patients with venous thromboembolism (VTE). In the present study the correlations between some fibrinolytic compounds and future recurrent VTE were investigated. Blood samples for analysis of tissue-type plasminogen activator (t-PA) antigen before and after 10 min of venous occlusion (V.O.) and plasminogen activator inhibitor type 1 (PAI-1) activity were taken at 6 months after the first episode of VTE or the first recurrent VTE in 784 and 207 patients, respectively, who were anticoagulated for 1.5 or 6 months (first VTE) and 6 months or indefinitely (first recurrence). During a follow-up of 3-6 years from the event which qualified for inclusion there have been 177 recurrences. All initial and recurrent events were verified with objective diagnostic methods. Using cut off points of 10.0 ng/ml for t-PA antigen before V.O. and 30 AU/ml for PAI-1 in samples taken at rest, there were more patients above those levels in the groups with than without further recurrence (t-PA antigen, 50% versus 36%, p = 0.001; PAI-1, 18% versus 12%, p = 0.045). In the 495 patients, who received oral anticoagulation for 6 months, t-PA antigen at rest discriminated better, with 59% versus 34% of patients above 10 ng/ml in the groups with and without recurrence, respectively (p < 0.001). The t-PA antigen levels after V.O. and the fibrinolytic capacity (t-PA antigen after V.O. minus t-PA antigen before V.O.) were distributed similarly in patients with and without new recurrences. There was a statistically significant positive correlation between age and t-PA antigen (p < 0.001), and by analysis of covariance the difference between the groups with and without further recurrence regarding t-PA antigen disappeared. In conclusion, increased levels of PAI-1 and t-PA antigen in VTE-patients correlate with development of recurrent VTE within the next 3-6 years, but the value of these components in predicting future events for the individual patients is limited.

Anticoagulants↗

PubMed1995

[Pelvic recurrence of cervical cancer: the prognostic relationship to the retreatment modalities].

OBJECTIVE: To investigate the prognostic factors in relation to retreatment modalities in patients with recurrent cervical carcinoma. METHODS: According to initial therapy, 194 patients with recurrence were grouped as: (1) surgery, 22 cases; (2) surgery and radiotherapy, 24 cases, and (3) radiotherapy alone, 148 cases. Factors such as clinical stage, sites of recurrence, time of diagnosis of recurrence after initial therapy and modalities of retreatment were analyzed. RESULTS: There were 19 cases alloted to stage I, 51 cases to stage II (IIa 23 and IIb 28) and 124 cases to stage III (IIIa 21 and IIIb 103); histopathologically confirmed squamous cell carcinoma in 181 cases and adenocarcinoma 13 cases. Central recurrences were found in 91 cases and lateral or pelvic recurrences in 103 cases. Time of diagnosis of recurrence within 2 years from initial treatments was shown in 118 patients and above 2 years in 76 patients. In 147 of the 194 patients retreated, those of the group 1 obtained a median survival rate of 24 months, which was significantly longer than that of group 2, and group 3. The sites of recurrence did not significantly affect the survival. CONCLUSION: Radiotherapy remains the treatment of choice for patients with pelvic recurrence after surgery. Previously irradiated patients retreated for recurrence by radiotherapy and (or) chemotherapy had lower response rates. The optimal therapy for these patients should be comprehensive managements including surgery, radiotherapy and chemotherapy.

Carcinoma, Squamous Cell↗

PubMed1996

[More recurrencies than expected following inguinal hernia surgery].

OBJECTIVE: To make an inventory of inguinal hernia repairs performed in one year, and to analyse the number of and origin of recurrent hernias. DESIGN: Retrospective. SETTING: Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands. METHOD: Analysis of all hernia operations performed in Amsterdam and Amstelveen in 1994 in male patients over 18 years of age. Request of national data, computer data from the hospitals, hand count of all operation reports and investigation of patient files. RESULTS: In 1994, 1108 patients were operated for inguinal hernia on one or two sides. In 216/1108 (19.5%) cases recurrent hernia was involved. According to national statistics this occurred in 175/1123 (15.6%). In the two University hospitals 25.7% of all repairs were for a recurrent hernia, in the two hospitals with a surgical training programme this proportion was 17.9% and in the five hospitals without a training programme it was 18.6%. Of the early recurrences (within two years) 82.5% (47/57) were reoperated in the same hospital as before but of the late recurrences (more than 10 years) this proportion was only 26.8%. Only 16.6% (36/216) of the patients with a recurrence were reoperated by the same surgeon who had performed the prior operation. Most popular method for repair was a Bassini (59%). In the training hospitals more early recurrences were repaired than in the non-training hospitals. CONCLUSION: The percentage of hernia repairs for recurrent hernia is higher than national statistics suggest and higher than expected. Surgeons have little insight into their performance as many recurrences are repaired by another surgeon and many recurrences occur after ten years. Better training and more use of modern techniques may improve results.

Academic Medical Centers↗

PubMed1997

Patterns of tumor recurrence and guidelines for followup after nephron sparing surgery for sporadic renal cell carcinoma.

PURPOSE: We delineated patterns of tumor recurrence and developed guidelines for followup after nephron sparing surgery for sporadic renal cell carcinoma. MATERIALS AND METHODS: Before December 1994, 327 patients underwent nephron sparing surgery for sporadic localized renal cell carcinoma at our clinic. Mean postoperative followup was 55.6 months. The course and outcome for patients with postoperative recurrent renal cell carcinoma were reviewed in detail. RESULTS: Renal cell carcinoma recurred after nephron sparing surgery in 38 patients (11.6%), including 13 (4.0%) who had local tumor recurrence with (7) or without (6) metastatic disease and 25 (7.6%) who had metastatic disease without local tumor recurrence. Recurrent renal cell carcinoma was detected by associated symptoms in 25 patients and by a followup chest x-ray or abdominal computerized tomography (CT) in 13. The respective incidences of postoperative local tumor recurrence and metastatic disease according to initial pathological tumor stage were 0 and 4.4% for stage T1, 2.0 and 5.3% for stage T2, 8.2 and 11.5% for stage T3a, and 10.6 and 14.9% for stage T3b disease. The peak postoperative intervals until local tumor recurrence were 6 to 24 months (7 of 10 patients with stage T3 renal cell carcinoma) and longer than 48 months (all 3 with stage T2 disease). Patients with isolated local tumor recurrence had better survival compared to those with local tumor recurrence and metastatic disease or metastases only. CONCLUSIONS: Followup for recurrent malignancy after nephron sparing surgery for renal cell carcinoma can be tailored according to the initial pathological tumor stage. All patients should be evaluated yearly with a medical history, physical examination and select laboratory studies. Patients with stage T1 renal cell carcinoma require no additional monitoring, while those with stage T2 disease should also undergo a yearly chest x-ray and abdominal CT every 2 years. The same recommendations are offered for patients with stage T3 renal cell carcinoma except that abdominal CT should be done every 6 months for the first 2 years postoperatively.

Aged↗