De blinde vlekken in de follow-up na (partiële) nefrectomie voor niercelcarcinoom

The blind spots in follow-up after nephrectomy for renal cell carcinoma Introduction:: Objective of this study was to identify patients who might benefit from future improvements in (national Dutch) guidelines regarding follow up (FU) after nephrectomy for renal cell carcinoma (RCC). Patients and methods:: All recurrences after (partial) nephrectomy performed between 2000 and 2010 were categorized as either being detected within or outside the duration of the guideline FU scheme. Also symptomatic presentation and survival were screened. Results:: 81 out of 398 patients developed recurrent disease after (partial) tumornephrectomy. Mean time to recurrence in months was 54 (n = 5) for T1a, 56 (n = 16) for T1b, 24 (n = 18) for T2, 20 (n = 39) for T3 and 11 (n = 2) for T4 tumours. Detection of recurrence within 6 months occurred in 28[%] of patients with recurrence, of which 65[%] were T3 or T4 tumours. Of the T1a tumors 40[%] recurred = five years after nephrectomy, for T1b that was 50[%]. No significant benefit in survival between diagnosed within versus outside the FU schedule and symptomatic versus asymptomatic presentation was found. Conclusion:: A more intensive FU the first six months after nephrectomy for higher staged and a FU scheme > five years especially for T1b tumors might improve early and asymptomatic detection of recurrent disease after nephrectomy for RCC.