Local recurrence after nephrectomy for primary renal cancer: computerized tomography recognition.

We diagnosed by computerized tomography 15 local recurrences in 88 patients who had undergone nephrectomy for renal cancer, with no false positives and 1 false negative. This over-all low rate (17 per cent) probably is owing to the fact that computerized tomography scans were done in patients in good clinical condition. Local recurrence was noted in 3 of 59 asymptomatic patients and in 12 of 19 patients with local symptoms. No recurrence was noted in 10 patients with general symptoms. Thus, 20 per cent of local recurrences were asymptomatic and 80 per cent presented with local symptoms. High local recurrence rates were found in cases of transitional cell carcinoma with whole wall involvement or extension to adjacent tissues (4 of 8 patients, 50 per cent), clear cell adenocarcinoma with lymph node involvement (3 of 7 patients, 43 per cent) and partial nephrectomy (3 of 6 patients, 50 per cent). Therefore, we consider such patients to be at high risk. Our study demonstrates that computerized tomography enables earlier, accurate diagnosis of smaller local recurrence in asymptomatic patients and provides a sensitive, reliable, noninvasive, repetitive method of evaluation of clinical treatment trials. Routine followup should be reserved for high risk patients.