Followup

Patients undergoing laparoscopic nephron-sparing surgery for renal cancer case are advised to return for initial follow-up four weeks postoperatively. At that time, physical examination to exclude surgical complications, serum hemoglobin and hematocrit to assess recovery of perioperative blood loss, serum creatinine measurement, and a MAG-3 radionuclide renal scan are obtained to document renal function and anatomy. In patients with impaired overall renal function, a renal ultrasound or a magnetic resonance imaging is performed instead of the renal scan.

Hafez et al. (129) developed guidelines for long-term surveillance after nephron-sparing surgery for renal cancer case. Tumor recurrence patterns after nephron-sparing surgery for sporadic localized renal cancer case were analyzed in 327 patients. renal cancer case recurred postoperatively in 11.7% of patients. According to initial pathologic tumor stage, they reported the incidence of postoperative local tumor recurrence and metastatic disease as follows: 0% and 4% for T1 renal cancer case, 2% and 5.3% for T2 renal cancer case, 8.2% and 11.5% for T3a renal cancer case, and 10.6% and 14.9% for T3b renal cancer case. They recommended a surveillance scheme including annual evaluation of medical history, physical examination, and selected blood studies (serum calcium, alkaline phosphatase, liver function tests, blood urea nitrogen, serum creatinine, and electrolytes). A 24-hour urinary protein measurement should be obtained in patients with a solitary remnant kidney to screen for hyperfiltration nephropathy. Patients who undergo nephron-sparing surgery for pT1 renal cancer case do not require radiographic imaging postoperatively. A yearly chest radiograph is recommended after nephron-sparing surgery for pT2 or pT3 renal cancer case. Abdominal computed tomograpgy scanning is indicated every two years in patients with pT2 renal cancer case, and every six months for two years, then every two years in patients with pT3 renal cancer case.

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