Author's Accepted Manuscript Surgical Management for Local Retroperitoneal Recurrence Of Renal Cell Carcinoma After Radical Nephrectomy Arun Z. Thomas , Mehrad Adibi , Leonardo D. Borregales , Ly N. Hoang , Pheroze Tamboli , Eric Jonasch , Nizar M. Tannir , Surena F. Matin , Christopher G. Wood , Jose A. Karam PII: DOI: Reference:
S0022-5347(15)03271-1 10.1016/j.juro.2015.02.2943 JURO 12419
To appear in: The Journal of Urology Accepted Date: 23 February 2015 Please cite this article as: Thomas AZ, Adibi M, Borregales LD, Hoang LN, Tamboli P, Jonasch E, Tannir NM, Matin SF, Wood CG, Karam JA, Surgical Management for Local Retroperitoneal Recurrence Of Renal Cell Carcinoma After Radical Nephrectomy, The Journal of Urology® (2015), doi: 10.1016/ j.juro.2015.02.2943. DISCLAIMER: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our subscribers we are providing this early version of the article. The paper will be copy edited and typeset, and proof will be reviewed before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to The Journal pertain.
Embargo Policy All article content is under embargo until uncorrected proof of the article becomes available online. We will provide journalists and editors with full-text copies of the articles in question prior to the embargo date so that stories can be adequately researched and written. The standard embargo time is 12:01 AM ET on that date. Questions regarding embargo should be directed to [email protected].
ACCEPTED MANUSCRIPT
Surgical Management for Local Retroperitoneal Recurrence Of Renal Cell Carcinoma After Radical Nephrectomy Arun Z. Thomasa, Mehrad Adibia, Leonardo D. Borregalesa, Ly N Hoanga, Pheroze Tambolib, Eric Jonaschc, Nizar M. Tannirc, Surena F. Matina, Christopher G. Wooda, Jose A. Karama* a
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*Corresponding Author: Jose A. Karam, MD, FACS Assistant Professor The University of Texas MD Anderson Cancer Center Department of Urology 1515 Holcombe Blvd, Unit 1373 Houston, TX 77030 Phone: 713-792-3250 Fax: 713-794-4824 Email: [email protected]
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Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA b Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA c Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Keywords: retroperitoneal recurrence, renal cell carcinoma, local recurrence, radical nephrectomy, renal fossa, lymph node, adrenal
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Word count of abstract: 241 Word count of text: 2,578
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Conflict of Interest: Jose A. Karam acted as a one-time consultant for Pfizer in 2013, which is
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unrelated to the current submitted manuscript.
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ACCEPTED MANUSCRIPT
ABSTRACT
Purpose: Isolated local retroperitoneal recurrence (RPR) after radical nephrectomy (RN) for
patients with localized RPR treated with surgical resection.
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renal cell carcinoma (RCC) poses a therapeutic challenge. We investigated the outcomes of
Methods: This was a retrospective single-institutional study of 102 patients with RPR treated
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with surgery from 1990-2014. Demographics, clinical and pathological features, location of RPR, perioperative complications were reported using descriptive statistics. Recurrence free
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survival (RFS) and cancer-specific survival (CSS) were studied using univariate and multivariate analyses.
Results: Median age at RPR diagnosis was 55 years (IQR 49-64). Sixty-two (60.8%) patients were pT3-4 and 20 (19.6%) were pN1. No patients had distant metastatic disease at time of RPR
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surgery. Median time from nephrectomy to RPR diagnosis was 19 months (IQR 5-38.8). The median size of resected RPR was 4.5cm (IQR 2.7-7). Median follow up after RPR surgery was 32 months (IQR 16-57). Metastatic progression was observed in 60 (58.8%) patients after RPR
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surgery. Neoadjuvant and salvage systemic therapy were administered in 46 (45.1%) and 48 (47.1%) patients, respectively. On multivariate analysis, pathological nodal stage at original
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nephrectomy and maximum diameter of RPR were identified as independent risk factors for cancer specific death.
Conclusion: Clinico-pathological factors at the time of nephrectomy as well as RPR surgery are important prognosticators. Aggressive surgical resection offers potential cure in a substantial number of patients with RPR with acceptable complications, and still plays a dominant role in the management of isolated locally recurrent RCC.
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ACCEPTED MANUSCRIPT
INTRODUCTION
Renal cell carcinoma (RCC) is an increasingly common malignancy. Even with curative
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RN, 20-40% of patients develop metastatic disease.1-5 Of these, untreated patients have a poor 5year survival rate of
S0022-5347(15)03271-1 10.1016/j.juro.2015.02.2943 JURO 12419
To appear in: The Journal of Urology Accepted Date: 23 February 2015 Please cite this article as: Thomas AZ, Adibi M, Borregales LD, Hoang LN, Tamboli P, Jonasch E, Tannir NM, Matin SF, Wood CG, Karam JA, Surgical Management for Local Retroperitoneal Recurrence Of Renal Cell Carcinoma After Radical Nephrectomy, The Journal of Urology® (2015), doi: 10.1016/ j.juro.2015.02.2943. DISCLAIMER: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our subscribers we are providing this early version of the article. The paper will be copy edited and typeset, and proof will be reviewed before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to The Journal pertain.
Embargo Policy All article content is under embargo until uncorrected proof of the article becomes available online. We will provide journalists and editors with full-text copies of the articles in question prior to the embargo date so that stories can be adequately researched and written. The standard embargo time is 12:01 AM ET on that date. Questions regarding embargo should be directed to [email protected].
ACCEPTED MANUSCRIPT
Surgical Management for Local Retroperitoneal Recurrence Of Renal Cell Carcinoma After Radical Nephrectomy Arun Z. Thomasa, Mehrad Adibia, Leonardo D. Borregalesa, Ly N Hoanga, Pheroze Tambolib, Eric Jonaschc, Nizar M. Tannirc, Surena F. Matina, Christopher G. Wooda, Jose A. Karama* a
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*Corresponding Author: Jose A. Karam, MD, FACS Assistant Professor The University of Texas MD Anderson Cancer Center Department of Urology 1515 Holcombe Blvd, Unit 1373 Houston, TX 77030 Phone: 713-792-3250 Fax: 713-794-4824 Email: [email protected]
SC
RI PT
Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA b Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA c Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Keywords: retroperitoneal recurrence, renal cell carcinoma, local recurrence, radical nephrectomy, renal fossa, lymph node, adrenal
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EP
Word count of abstract: 241 Word count of text: 2,578
1
ACCEPTED MANUSCRIPT
Conflict of Interest: Jose A. Karam acted as a one-time consultant for Pfizer in 2013, which is
AC C
EP
TE D
M AN U
SC
RI PT
unrelated to the current submitted manuscript.
2
ACCEPTED MANUSCRIPT
ABSTRACT
Purpose: Isolated local retroperitoneal recurrence (RPR) after radical nephrectomy (RN) for
patients with localized RPR treated with surgical resection.
RI PT
renal cell carcinoma (RCC) poses a therapeutic challenge. We investigated the outcomes of
Methods: This was a retrospective single-institutional study of 102 patients with RPR treated
SC
with surgery from 1990-2014. Demographics, clinical and pathological features, location of RPR, perioperative complications were reported using descriptive statistics. Recurrence free
M AN U
survival (RFS) and cancer-specific survival (CSS) were studied using univariate and multivariate analyses.
Results: Median age at RPR diagnosis was 55 years (IQR 49-64). Sixty-two (60.8%) patients were pT3-4 and 20 (19.6%) were pN1. No patients had distant metastatic disease at time of RPR
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surgery. Median time from nephrectomy to RPR diagnosis was 19 months (IQR 5-38.8). The median size of resected RPR was 4.5cm (IQR 2.7-7). Median follow up after RPR surgery was 32 months (IQR 16-57). Metastatic progression was observed in 60 (58.8%) patients after RPR
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surgery. Neoadjuvant and salvage systemic therapy were administered in 46 (45.1%) and 48 (47.1%) patients, respectively. On multivariate analysis, pathological nodal stage at original
AC C
nephrectomy and maximum diameter of RPR were identified as independent risk factors for cancer specific death.
Conclusion: Clinico-pathological factors at the time of nephrectomy as well as RPR surgery are important prognosticators. Aggressive surgical resection offers potential cure in a substantial number of patients with RPR with acceptable complications, and still plays a dominant role in the management of isolated locally recurrent RCC.
3
ACCEPTED MANUSCRIPT
INTRODUCTION
Renal cell carcinoma (RCC) is an increasingly common malignancy. Even with curative
RI PT
RN, 20-40% of patients develop metastatic disease.1-5 Of these, untreated patients have a poor 5year survival rate of
