Laparoscopic Completion Nephrectomy for Local Surgical Bed Recurrence After Partial Nephrectomy: An Analysis of Procedural Complexity and Feasibility.

OBJECTIVES: To study the feasibility and perioperative outcomes associated with a laparoscopic approach to completion nephrectomy in patients with locoregional disease recurrence after partial nephrectomy (PN) for renal cell carcinoma.

PATIENTS AND METHODS: We performed a retrospective review of patients who underwent PN between 2006 and 2016 and developed locoregional recurrence, defined by the presence of new disease within the original surgical bed. Those undergoing planned laparoscopic completion nephrectomy constituted the study cohort. Perioperative outcomes as well as clinical and pathologic parameters associated with ability to effectively perform laparoscopic completion nephrectomy were assessed.

RESULTS: Among 1259 patients who underwent PN during the study period, 45 cases (3.6%) of locoregional disease recurrence were observed. A laparoscopic approach to completion nephrectomy was attempted in 33 patients. Overall, 16 (48.5%) patients experienced a postoperative complication, 9 of whom (27.3%) had a major event (Clavien grade ≥3). Intraoperative open conversion was necessary in 12 (36%) patients. Higher R.E.N.A.L score of the original tumor (p < 0.001) and clinical evidence of synchronous metastatic relapse (p < 0.001) were associated with increased likelihood of open conversion. Blood loss (725 mL vs 175 mL, p < 0.001), operative time (280 minutes vs 160 minutes, p < 0.001), risk of major postoperative complication (58% vs 9.5%, p = 0.005), and hospital length of stay (4.5 days vs 2 days, p = 0.026) were significantly higher in individuals requiring open conversion.

CONCLUSION: Laparoscopic completion nephrectomy for true locoregional recurrence is a technically demanding procedure associated with significant postoperative morbidity and a high rate of open conversion. Although feasible, careful patient selection may optimize surgical outcomes.