Follow-up after radical kidney surgery is intended to identify/monitor:
recurrence in contralateral kidney
development of metastases
Today there is no clear evidence of the value of follow-up after radical surgery for renal cell carcinoma. Three larger studies have concluded that follow-up should be based on the pathologic tumor stage, tumor size, DNA ploidy, and possibly grading. Most recurrences (85%) were found within the first three years after surgery. Lung metastases were the first localization in 38-54%, and were often asymptomatic. This is followed by bone metastases in 18–27%, intraabdominal metastases in 13–16%, and brain metastases in 4–8% (5,10,11). A condition for follow-up is that there is a treatment possibility for recurrences in the form of metastasis surgery, immunotherapy, or radiation therapy, and that the patient has the physical condition to undergo treatment.
Postoperative complications and kidney function are evaluated on the basis of patient history, physical examination, and measurement of serum creatinine. Repeated measurement of creatinine is indicated for preoperatively reduced kidney function, or for postoperative increase of serum creatinine level. Local recurrence is rare, but early diagnosis is important since the most effective treatment is cytoreductive surgery. Recurrence in the contralateral kidney is also relatively rare.
One of the purposes of follow-up is to identify metastases as early as possible since more advanced tumor growth will reduce the possibility for surgical resection. It is standard therapy to remove resectable tumors by surgery. This is also recommended for solitary metastatic lesions.
Patients with von Hippel-Lindau's syndrome are recommended to have yearly follow-up with CT. Carcinoma can be identified early, which will allow the patient the possibility of kidney-sparing surgery.