Diagnosis And Surgical Operation Of Local Recurrence For T1a Renal Cell Carcinoma After Retroperitoneal Laparoscopic Partial Nephrectomy:Three Cases Report And Literature Review

Objectives:To report the clinical features,management and prognosis of local recurrence after Retroperitoneal laparoscopic partial nephrectomy,and to discuss the postoperative follow-up of laparoscopic partial nephrectomy and the treatment of local recurrence. Methods:Analyzed the clinical features of three cases,which with local recurrence after laparoscopic partial nephrectomy and without the remaining parts of recurrence/metastasis,in Fujian Provincial Hospital from March 2013 to October 2015.In these three cases, the case one was a 52 years old female, the first onset of CT check found that tumor size was 3.7cm X3.3cm, located in the lower pole of the right kidney, the clinical diagnosis was T1 a N0M0;the case two was a 79 years old male, the first onset of MRI examination found that tumor size was 3.9cm X3.3cm X 4.2cm due to flank pain, located in the upper part of the right kidney, the clinical diagnosis was T1 b N0M0;the case three was a 65 years old male, the first onset of CT check found that the tumor is located in the upper part of the right kidney due to visible haematuria, the size of the diameter of about 1.6cm, the clinical diagnosis was T1 a N0M0.They were all diagnosed early,and then treated by Retroperitoneal Laparoscopic Partial Nephrectomy.And we sutured the perinephric fat to restore the perinephric anatomical structure after remove the pathological tissue in case one and case three,while did not in case two(In the other hospital for surgery).Their surgical margins were negative,and their pathological were clear renal cell carcinoma.Fuhrman grade were: grade ?, grade ?, grade ?.Three patients were regular follow-up after operation.And patient one taked sorafenib 400 mg bid for 3 months,while the other two not. Results:Local recurrence occurred 1year,2year and a half,2years later after surgery.Patient one was diagnosed by CT follow-up that lesions located in the upper pole of the right kidney, size of 1.0 cm x 2.3 cm,whose biopsy diagnosis of renal clear cell carcinoma and clinical diagnosis is c T1 a N0M0.Patient two was diagnosed by MRI examination due to right flank pain again that lesions located in the original operation area, diameter of about 0.9cm and clinical diagnosis is c T1 a N0M0.Patient three was diagnosed by CT check due to visible haematuria again.The tumors located in the upper pole of the right kidney, 2.7 cm in diameter and clinical diagnosis is c T1 a N0M0.Patient one and three were treated by Laparoscopic radical nephrectomy on right kidney.Patient one with perinephric fat mild adhesion,and patient three's severe adhesion.Patient two couldn't tolerate surgery again because of age, poor physical candition,so we treated him by Radiofrequency ablation.Three pathological were clear renal cell carcinoma,and patient one and patient three's Fuhrman grade were grade while patient two didn't grade by ?nuclear.The patient one's tumor was multicenter.Three pathological diagnosis were renal clear cell carcinoma.Three patients were regular follow-up after operation.Patient one continue taking sorafenib 400 mg bid,and no recurrence or metastasis occurred during 1 year follow-up.Patient two's CT follow-up prompted the original surgical area suspected recurrence half year later after surgery.But patients and their families do not want to radiofrequency ablation again,taking into account the age and poor physical condition.No recurrence or metastasis occurred during 1 year follow-up for patient three. Conclusions:In patients with high risk factors,intense follow-up is needed.and the follow mainly base on imaging such as CT and MRI.For local recurrence with no distant metastasis, reoperation is difficult, but intraperitoneal laparoscopic radical nephrectomy is safe and feasible.Some patients with advanced age, poor body condition but tumors is small,who can't tolerate radical prostatectomy,can be treated with Radiofrequency ablation to prolong disease-free survival.In addition,perinephric fat should be sutured to restore the perinephric anatomica structure to reduce the adhesion during LPN.