Editing Management of Localized and Locally Advanced Disease (section)

== Local Recurrence after Radical Nephrectomy or Nephron-Sparing Surgery ==

* '''Local recurrence is defined as any persistent or recurrent disease present in the treated kidney or associated renal fossa after initial treatment.'''
** Includes recurrence in the renal fossa, ipsilateral adrenal gland, or ipsilateral retroperitoneal lymph nodes
* Uncommon, occurs in 2-4% of cases
* Risk factors include locally advanced or node-positive disease and adverse histopathologic features
* '''Associated with a poor prognosis'''
* '''Management'''
** Patients who are found to have a new renal primary tumor, or a local recurrence above should undergo a metastatic evaluation (CT chest and either CT or MRI abdomen are preferable).
** '''2021 AUA: For appropriately selected patients with good performance status and an isolated new renal primary tumor or a local recurrence, surgery or ablation should be considered for definitive management.'''
*** Can provide long-term cancer-free status for 30-40% of patients
*** '''Patients with local recurrence treated non-surgically have a low survival rate'''
*** '''The best outcomes are reported in those patients treated with surgical resection for isolated local recurrence only'''
**** '''The presence of synchronous metastasis (e.g. lung metastasis) is associated with a significantly lower survival rate.'''
**** Other factors, including time to local recurrence, location in the ipsilateral adrenal or renal fossa, and size of local recurrence are NOT independently associated with a worse outcome.
* '''Patients with isolated local recurrence after PN can be considered for repeat PN, completion nephrectomy, TA, or AS'''
* '''See Metastectomy for Distant Recurrence Section in Advanced Kidney Cancer Chapter Notes'''