From the Guidelines
Surveillance imaging after partial nephrectomy for renal cell carcinoma should continue for at least 5 years, with a risk-based approach guiding the frequency of imaging, as recommended by the European Association of Urology guidelines updated in 2022 1, 2. The surveillance schedule should be individualized based on the patient's risk profile, with low-risk patients undergoing less frequent imaging and high-risk patients requiring more intensive follow-up.
- The proposed surveillance schedule includes: + Low-risk patients: CT scans at 3, 12, 24 months, and then every 2 years + Intermediate-risk patients: CT scans at 3, 6, 12, 18, 24 months, and then annually for 5 years, followed by every 2 years + High-risk patients: CT scans at 3, 6, 12, 18, 24 months, and then annually, with continued annual imaging beyond 5 years The use of ultrasound as an alternative to CT or MRI scans can be considered to reduce radiation exposure, especially in patients with a low risk of recurrence. Regular clinical examinations and laboratory tests, including comprehensive metabolic panel and renal function tests, should also be performed during follow-up visits to monitor for potential complications and recurrence. The risk of recurrence decreases significantly beyond 5 years, but some centers may continue annual imaging for up to 10 years for high-risk patients, as supported by studies such as those published in the Journal of the National Comprehensive Cancer Network 3 and the Journal of Urology 4.
From the Research
Surveillance Imaging after Partial Nephrectomy
- The duration of surveillance imaging after partial nephrectomy for renal cell carcinoma is not explicitly stated in the provided studies.
- However, a study from 2003 5 mentions that approximately 50% of patients will develop a disease recurrence, with two thirds of recurrences occurring within the first year.
- This suggests that surveillance imaging should be continued for at least several years after partial nephrectomy, with the exact duration depending on individual patient factors and risk of recurrence.
- The study also notes that proposed surveillance protocols using a stage-based approach or an integrated approach combining stage with other important prognostic factors can help identify treatable recurrences while minimizing unnecessary examinations and patient anxiety.
Factors Influencing Surveillance Imaging
- Patient comorbidities and willingness to pursue aggressive management in the event of recurrence may alter the follow-up protocol for each individual 5.
- The presence of solitary metastases, which has the greatest chance to achieve long-term survival, may also influence the duration and intensity of surveillance imaging.
- Other studies focus on the treatment of renal cell carcinoma, including partial nephrectomy 6, 7 and targeted therapy 8, 9, but do not provide specific guidance on the duration of surveillance imaging after partial nephrectomy.
Targeted Therapy and Surveillance Imaging
- A study from 2019 9 discusses the role of cytoreductive nephrectomy in the management of metastatic renal cell carcinoma in the targeted therapy era, but does not address the specific question of surveillance imaging after partial nephrectomy.
- The study suggests that systemic therapy should be prioritized in the management of patients with de novo metastatic renal cell carcinoma, and that nephrectomy may still have a role in selected patients.