| Abstract: |
Local tumor recurrence and isolated metastatic disease in renal cancer pose challenges to surgical and medical oncologists alike. In a historic context, local tumor recurrence in the resection bed or adjacent tissues after a prior radical nephrectomy (RN) was a rare clinical event. In a small percentage of carefully selected patients, surgical resection could lead to prolonged survival. In the contemporary practice of renal tumor surgery, the realm of local tumor recurrence has expanded to include new tumor recurrence after partial nephrectomy (PN), port site or abdominal disease after laparoscopic partial nephrectomy or radical nephrectomy (LPN, LRN), and persistent disease after thermal ablation. Although the resection of an isolated metastatic deposit can be associated with long-term survival, it is not understood whether the survival is the product of a therapeutic surgical event or simply variable renal cancer natural history. Metastasectomy is now expanding as a surgical option following the recent introduction of tyrosine kinase and mTOR inhibitors which are dramatically increasing the life expectancy of patients with metastatic renal cancer and able to induce marked regression of metastatic lesions and renal primaries alike. Important patient selection factors have significant prognostic value and are associated with long-term survival of metastatic renal cancer patients whether treated medically or surgically. In this chapter, the contemporary role of surgical resection in the management of local tumor recurrence and isolated metastatic disease will be discussed. © Springer Science+Business Media New York 2013. |
