Oncological control associated with surgical resection of isolated retroperitoneal lymph node recurrence of renal cell carcinoma.

OBJECTIVE: To evaluate the outcome of patients after surgical resection of isolated retroperitoneal lymph node (RPLN) recurrence of renal cell carcinoma (RCC) using a multicentre international cohort. PATIENTS AND METHODS: In all, 50 patients were identified who underwent resection of isolated RPLN recurrence of RCC at four institutions after nephrectomy for pTany Nany M0 disease. Progression-free (PFS) and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method. Cox proportional hazards regression models were used to assess the association of clinicopathological characteristics with disease progression. RESULTS: The median (interquartile range, IQR) age at resection was 57.0 (50.0-62.5) years. The median (IQR) time to RPLN recurrence after nephrectomy was 12.6 (6.9-39.5) months, with no significant difference in median time to RPLN recurrence between patients with N+ disease at nephrectomy (10.7 [6.5-24.6] months) and those with Nx/pN0 disease at nephrectomy (13.7 [8.7-44.2] months) (P = 0.66). The median (IQR) size of the RPLN recurrence before resection was 2.6 (1.9-5) cm. The most common site for RPLN recurrence was within the interaortocaval region (34%). The median (IQR) follow-up after RPLN resection for patients alive at last follow-up was 28.0 (13.7-51.2) months. During follow-up, 26 patients developed RCC recurrence, at a median (IQR) of 9.9 (4.0-18.5) months after RPLN resection. Of those who developed a secondary recurrence, disease was again isolated to the retroperitoneum in seven patients. In all, 11 patients subsequently died, including 10 who died from disease. The median PFS after RPLN resection was 19.5 months, with a 3- and 5-year PFS of 40.5% and 35.4%, respectively. We also found that RPLN recurrence at ≤12 months after nephrectomy was associated with a significantly inferior median PFS (12.3 months) compared with RPLN recurrence at >12 months after nephrectomy (47.6 months; P = 0.003). Moreover, on multivariate analysis, a shorter time to recurrence remained associated with a significantly increased risk for subsequent disease progression (hazard ratio 3.51; P = 0.005). CONCLUSION: Surgical resection of isolated RPLN recurrence from RCC may result in durable cancer control in appropriately selected patients. Recurrence at ≤12 months after nephrectomy was associated with a significantly increased risk of progression after resection, underscoring the importance of this variable for risk stratification. Thus, we recommend that, in the setting of isolated RPLN recurrence of RCC (in patients without precluding comorbidities), careful consideration with the patients and medical oncology colleagues be undertaken about the relative and individualised benefits of surgical resection, systemic therapy, and surveillance.

Laparoscopic management of isolated nodal recurrence in gynecological malignancies is safe and feasible even for large metastatic nodes up to 8 cm: A prospective case series.

BACKGROUND: The surgical treatment of isolated lymph node recurrence (ILNR) of gynecological malignancies is still debated. The feasibility and effectiveness of minimally invasive lymphadenectomy have been reported by few studies; however, it remains unclear what the upper tumor size limit is for a minimally invasive approach. We prospectively analyzed cases of ILNR treated by laparoscopy in our unit while focusing on the safety and feasibility of resecting large tumors suspected of recurrence using a minimally invasive approach. MATERIALS AND METHODS: We carried out a prospective observational case-series study. We included all consecutive patients with ILNR from gynecological cancers who underwent minimally invasive lymphadenectomy at our unit from June 2013 to June 2021 to assess the safety and feasibility of such a surgical approach. We also evaluated the oncological outcome in terms of further recurrence, site of recurrence, and survival. RESULTS: Twenty-seven patients with ILNR due to gynecological malignancies were included (ovarian cancer, 12; uterine malignancies, 12; cervical cancer, 3). Three had remarkably large LNs up to 8 cm: these emblematic cases have been reported in detail with accompanying videos of the surgical procedure. The most frequent site of ILNR was aortic (67%). Recurrent LNs were completely resected in all cases; none of the procedures was converted to open surgery. The median follow-up duration was 24 months. Ten patients (37%) had a new recurrence. To date five patients (18.5%) have succumbed, four (14.8%) are alive with evidence of disease, and 18 (66.7%) are alive with no evidence of disease. CONCLUSIONS: Minimally invasive surgery for ILNR in gynecological malignancies may be an option feasible, safe, and effective in terms of oncological outcomes, even for large tumors. It also allows quicker recovery with early initiation of appropriate postoperative systemic chemotherapy, in the context of an optimal multimodal therapeutic approach.

[Laparoscopic Surgery for isolated lymph nodes recurrence in gynecology. Experience in Argentina.] / Citoreducción Ganglionar Laparoscópica en recidiva única por cánceres ginecológicos. Experiencia en Argentina.

Objectives: to describe the perioperative and oncological outcomes of a serie of cases treated with laparoscopic surgery for isolated nodal metastasis of gynecologic malignancies at the Gynecology Service of Hospital Italiano de Buenos Aires and conduct a literature review on the surgical treatment provided to patients with this condition. Methods: A search was conducted in the surgery records of the Gynecology Service of Hospital Italiano of patients who underwent laparoscopic cytoreductive surgery for isolated nodal recurrence of a gynecologic primary tumor in the period 2009-2015. The medical records were reviewed and data on the patients' characteristics, the tumor, the surgery and its complications were collected and analyzed. A literature search was conducted in Pubmed by the term "isolated nodal recurrence in gynecology" and a subsequent snowball search was performed. Results: As results, nine patients are presented. The median age was 66 years old (RI 7). The initial cancer location was: ovary (n=3), endometrium (n=3), cervix (n=2) and breast (n=1). The location site of the single nodal recurrence was the para-aortic area (n=8) and the pelvic area (n=1). The median of the disease-free interval to recurrence was 42.8 months (RI 40.2). Either the retroperitoneal or the transperitoneal approach was used based on the location of the recurrence. The median surgery time was 120 minutes (RI 36). No conversion to laparotomy was performed in any patient. No intraoperative or postoperative complications were reported, nor any requirement for blood transfusion. The median hospital stay was 36 hours. Adjuvant treatment with chemotherapy was applied to 8/9 patients. Only one patient recurred in para-aortic lymph nodes and peritoneal carcinomatosis after eight months and died of her disease. The literature review confirms the possibility of laparoscopic resection of the single nodal recurrence with low complication rate. Conclusion: The laparoscopic lymph node cytoreductive surgery is a valid and safe treatment option considering the perioperative and oncological outcomes in our hospital.

Objetivos: Describir los resultados perioperatorios y oncológicos de una serie de casos operados con laparoscopía por metástasis única ganglionar de cánceres ginecológicos en el Servicio de Ginecología del Hospital Italiano de Buenos Aires y realizar una revisión bibliográfica sobre el tema. Métodos: Se llevó a cabo una búsqueda de pacientes en los registros de cirugía del servicio de Ginecología del Hospital que hayan recibido tratamiento quirúrgico de citoreducción laparoscópica por recurrencia ganglionar aislada de un tumor primario ginecológico en el período 2009-2015. Se revisaron las historias clínicas y se recolectaron y analizaron datos referidos a características de las pacientes, del tumor, de la cirugía y sus complicaciones. Se realiza una búsqueda bibliográfica en Pubmed con el concepto "isolated nodal recurrence in gynecology" y posterior búsqueda en bola de nieve. Resultados: Se presentan 9 pacientes. La mediana de edad fue de 66 años (RI 7). La localización del cáncer inicial fue ovario (n=3), endometrio (n=3), cuello (n=2) y mama (n=1). El sitio de localización de la recurrencia ganglionar única fue el área lumboaórtica (n=8) y el área pelviana (n=1). La mediana de intervalo libre de enfermedad a la recurrencia fue de 42.8 meses (RI 40.2). Se utilizó un abordaje retroperitoneal o transperitoneal según la localización de la recurrencia. La mediana de tiempo operatorio fue de 120 minutos (RI 36). No se realizó conversión a laparotomía en ninguna paciente. No se reportaron complicaciones intraoperatoria o postoperatorias, así como tampoco requerimiento de transfusión sanguínea. La mediana de estadía hospitalaria fue de 36 horas. Realizaron tratamiento adyuvante con quimioterapia 8/9 pacientes. Solo 1 paciente recurrió a nivel lumboaórtico y peritoneal luego de 8 meses y falleció de su enfermedad.La revisión de la literatura confirma la posibilidad de realizar la resección de la recurrencia ganglionar única por vía laparoscópica con baja tasa de complicaciones. Conclusión: la citorreducción ganglionar laparoscópica es una opción de tratamiento válida y segura en relación a los resultados perioperatorios y oncológicos en nuestra institución.