Innovative Surgical Strategies for Reoperation of Local Recurrence in Renal Cell Carcinoma

Academic Background

Renal cell carcinoma (RCC) is one of the most common malignant tumors in adults, accounting for 5% of malignancies in males and 3% in females. Although surgery remains the standard treatment for localized RCC, nephron-sparing surgery (NSS) is considered superior to radical nephrectomy (RN) for treating localized T1a-b tumors. However, the risk of local recurrence after NSS persists, especially in cases of larger tumors or positive surgical margins (PSM). While studies have shown that NSS is comparable to RN in terms of long-term survival rates, managing local recurrence remains a challenge.

This study aims to explore the perioperative outcomes of reoperation for local recurrence of RCC after NSS and propose innovative surgical strategies. By analyzing data from a high-volume urological center, the research team hopes to provide practical recommendations for surgeons to optimize NSS and reoperation techniques.

Source of the Paper

This paper was co-authored by Wenming Ma, Wenlong Xu, Jialin Meng, and others from Anhui Medical University, and published online in the International Journal of Surgery on July 2, 2025. The research team is affiliated with the Department of Urology at the First Affiliated Hospital of Anhui Medical University and the Institute of Urology at Anhui Medical University.

Research Process

Study Subjects and Inclusion Criteria

The study retrospectively analyzed RCC patients who experienced local recurrence after NSS at the First Affiliated Hospital of Anhui Medical University between 2013 and 2023. Inclusion criteria included: initial surgery being NSS, recurrent tumors located in the ipsilateral kidney, and no distant metastasis. Ultimately, 15 eligible patients were included in the study.

Surgical Methods and Data Analysis

The research team meticulously recorded perioperative data, including operative time, estimated blood loss, and postoperative hospital stay. Surgical approaches included robot-assisted surgery (33.3%), laparoscopic surgery (40%), and open surgery (26.7%). During reoperation, 4 patients (26.7%) underwent NSS, while 11 patients (73.3%) underwent radical nephrectomy.

Data Analysis and Results

The results showed a median operative time of 215 minutes and a median estimated blood loss of 50 mL. The median postoperative hospital stay was 6 days. The study also found that the application of robot-assisted NSS increased annually, while the proportion of laparoscopic and open surgeries gradually decreased. Additionally, the research team proposed innovative surgical strategies, including avoiding renal hilum clamping during reoperation and using intraoperative ultrasound and hybrid resection techniques.

Key Findings

1. Surgical Safety: Few perioperative complications were observed after reoperation, indicating that reoperation is safe and feasible.
2. Popularization of Robot-Assisted Surgery: The application of robot-assisted NSS increased annually, demonstrating its advantages in complex surgeries.
3. Recurrence Time and Location: The median time to recurrence was 36 months, with most recurrences occurring at the original tumor resection site (86.7%).
4. Pathological Types: Most recurrent tumors were clear cell renal cell carcinoma (86.7%), and all patients had negative surgical margins.

Conclusions and Significance

The study concluded that reoperation after NSS is safe and effective. The innovative surgical strategies proposed by the research team provide valuable references for surgeons, particularly in managing complex cases of local recurrence after NSS. These strategies not only improve surgical success rates but also reduce postoperative complications.

Research Highlights

1. Innovative Surgical Strategies: The research team proposed strategies such as avoiding renal hilum clamping and using intraoperative ultrasound, offering new insights for reoperation.
2. Popularization of Robot-Assisted Surgery: The study demonstrated the increasing application of robot-assisted surgery in NSS, highlighting its advantages in complex urological procedures.
3. Management of Recurrence Risk: The study emphasized the importance of regular postoperative follow-ups for early detection and management of recurrence.

Additional Valuable Information

The study also noted that while NSS is comparable to RN in terms of long-term survival rates, the risk of recurrence remains, particularly in cases of larger tumors or positive surgical margins. Therefore, future research should further explore risk factors for recurrence and optimize techniques for NSS and reoperation.

---

Through this study, the research team from Anhui Medical University has provided significant clinical guidance for managing local recurrence of RCC after NSS, showcasing the potential of robot-assisted surgery in complex urological procedures.