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Recurrence pattern in localized RCC : results from a European multicenter database (RECUR)

Fallara, Giuseppe ; Larcher, Alessandro ; Dabestani, Saeed LU ; Fossati, Nicola ; Järvinen, Petrus ; Nisen, Harry ; Gudmundsson, Eirikur ; Lam, Thomas B. ; Marconi, Lorenzo and Fernandéz-Pello, Sergio , et al. (2022) In Urologic Oncology: Seminars and Original Investigations 40(11). p.11-494
Abstract

Introduction: The impact of open versus minimally invasive surgery on recurrence pattern in the management of localized renal cell carcinoma (RCC) remains uncertain. We thus aimed to determine the impact of surgical approach on survival and recurrence pattern. Material and methods: This is a multi-institutional, matched cohort study on patients with pT1-3aN0M0 RCC from the RECUR database. After propensity score matching between open and minimally invasive surgery, disease-free (DFS) survival and risk of first recurrence according to recurrence site, namely local recurrence, abdominal/retroperitoneal, thoracic/mediastinal or uncommon site metastases were investigated with Cox regression analysis. Overall (OS) and Cancer Specific Survival... (More)

Introduction: The impact of open versus minimally invasive surgery on recurrence pattern in the management of localized renal cell carcinoma (RCC) remains uncertain. We thus aimed to determine the impact of surgical approach on survival and recurrence pattern. Material and methods: This is a multi-institutional, matched cohort study on patients with pT1-3aN0M0 RCC from the RECUR database. After propensity score matching between open and minimally invasive surgery, disease-free (DFS) survival and risk of first recurrence according to recurrence site, namely local recurrence, abdominal/retroperitoneal, thoracic/mediastinal or uncommon site metastases were investigated with Cox regression analysis. Overall (OS) and Cancer Specific Survival (CSS) were also assessed. Results: After matching, 1,019 patients who underwent open and 1,019 who underwent minimally invasive surgery were included (of which 70 robot-assisted). At 5.2 years of median follow-up, 130 patients in open and 125 in minimally invasive group experienced disease progression. A higher risk of local recurrence (HR 2.06; 95% CI 1.18–3.58, P-value = 0.01) and uncommon site metastases (HR 1.09; 95% CI 1.01–1.16; P-value = .04) was found for minimally invasive surgery relative to open surgery, while no difference was found in terms of DFS (HR 0.83; 95% CI 0.64–1.06; P-value = .14). No differences were found in terms of OS and CSS. Main limitation is the retrospective nature of the study. Conclusions: The risk for local recurrence and uncommon site metastases was higher for minimally invasive surgery compared to open surgery, although no differences were found for OS, CSS, and DFS.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Disease free survival, Local recurrence, Minimally invasive surgery, Renal cancer, Uncommon sites metastasis
in
Urologic Oncology: Seminars and Original Investigations
volume
40
issue
11
pages
11 - 494
publisher
Elsevier
external identifiers
  • scopus:85138206554
  • pmid:36127233
ISSN
1078-1439
DOI
10.1016/j.urolonc.2022.08.007
language
English
LU publication?
yes
id
983e2c73-0f57-4d18-bd23-fe9706279c3f
date added to LUP
2022-12-05 11:11:51
date last changed
2024-04-04 13:30:06
@article{983e2c73-0f57-4d18-bd23-fe9706279c3f,
  abstract     = {{<p>Introduction: The impact of open versus minimally invasive surgery on recurrence pattern in the management of localized renal cell carcinoma (RCC) remains uncertain. We thus aimed to determine the impact of surgical approach on survival and recurrence pattern. Material and methods: This is a multi-institutional, matched cohort study on patients with pT1-3aN0M0 RCC from the RECUR database. After propensity score matching between open and minimally invasive surgery, disease-free (DFS) survival and risk of first recurrence according to recurrence site, namely local recurrence, abdominal/retroperitoneal, thoracic/mediastinal or uncommon site metastases were investigated with Cox regression analysis. Overall (OS) and Cancer Specific Survival (CSS) were also assessed. Results: After matching, 1,019 patients who underwent open and 1,019 who underwent minimally invasive surgery were included (of which 70 robot-assisted). At 5.2 years of median follow-up, 130 patients in open and 125 in minimally invasive group experienced disease progression. A higher risk of local recurrence (HR 2.06; 95% CI 1.18–3.58, P-value = 0.01) and uncommon site metastases (HR 1.09; 95% CI 1.01–1.16; P-value = .04) was found for minimally invasive surgery relative to open surgery, while no difference was found in terms of DFS (HR 0.83; 95% CI 0.64–1.06; P-value = .14). No differences were found in terms of OS and CSS. Main limitation is the retrospective nature of the study. Conclusions: The risk for local recurrence and uncommon site metastases was higher for minimally invasive surgery compared to open surgery, although no differences were found for OS, CSS, and DFS.</p>}},
  author       = {{Fallara, Giuseppe and Larcher, Alessandro and Dabestani, Saeed and Fossati, Nicola and Järvinen, Petrus and Nisen, Harry and Gudmundsson, Eirikur and Lam, Thomas B. and Marconi, Lorenzo and Fernandéz-Pello, Sergio and Meijer, Richard P. and Volpe, Alessandro and Beisland, Christian and Klatte, Tobias and Stewart, Grant D. and Bensalah, Karim and Ljungberg, Börje and Bertini, Roberto and Montorsi, Francesco and Bex, Axel and Capitanio, Umberto}},
  issn         = {{1078-1439}},
  keywords     = {{Disease free survival; Local recurrence; Minimally invasive surgery; Renal cancer; Uncommon sites metastasis}},
  language     = {{eng}},
  number       = {{11}},
  pages        = {{11--494}},
  publisher    = {{Elsevier}},
  series       = {{Urologic Oncology: Seminars and Original Investigations}},
  title        = {{Recurrence pattern in localized RCC : results from a European multicenter database (RECUR)}},
  url          = {{http://dx.doi.org/10.1016/j.urolonc.2022.08.007}},
  doi          = {{10.1016/j.urolonc.2022.08.007}},
  volume       = {{40}},
  year         = {{2022}},
}