In recent years laparascopic partial nephrectomy (LPN) has emerged as an oncologically safe alternative to its radical nephrectomy counterpart. There is however a lack of consensus amongst the urology community regarding surveillance after LPN for patients with stage I tumours. This timely review of T1 recurrence rates, from the Arthur Smith Institute for Urology in New York, comes as a welcome reminder to the urologist that, although rates are low, recurrences (both local and distant) do occur and are significant. A total of 360 patients underwent LPN for stage T1 (a and b) renal cell carcinoma. There were eight recurrences (2.2%). All of the tumours were of clear cell histology and none had Fuhrman grade I histology. Only one of these patients had a positive margin at the time of partial nephrectomy and all patients had a negative biopsy of the tumour resection bed. A majority of the recurrences occurred locally in the ipsilateral kidney or retroperitoneum. Most of the recurrences occurred within one to two years postoperatively. The 2.2% recurrence rate presented in this study is comparable to the published literature. The authors make two interesting comments. Firstly they report that “the significance of a positive surgical margin remains unclear”. It is considered safe practice to assume that, in the context of a positive surgical margin, the risk of subsequent recurrence is higher and therefore such patients should be followed up with care. Secondly, they recommend following up patients with T1 disease for more than five years. However, in this study the time to recurrence ranged from 14-53 months, and from larger series the value in follow-up beyond five years has not been proven. Nonetheless this is a common disease entity, whose incidence is increasing; we therefore await further long-term research to aide in our understanding of disease recurrence.

Renal cell recurrence for T1 tumors after laparoscopic partial nephrectomy?
Kreshover J, Richstone L, Kavoussi L.
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Hamid Abboudi

Imperial College Healthcare NHS Trust.

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