{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T19:00:54Z","timestamp":1786906854268,"version":"build-2736575974"},"reference-count":37,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:00:00Z","timestamp":1759968000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"\u201cRicerca Corrente\u201d funding from the Italian Ministry of Health"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Introduction and Objectives: Local recurrence (LR) in patients treated with surgery for renal cell carcinoma (RCC) remains a significant clinical challenge that requires thorough investigation. Our study aimed to identify the relative risk factors and explore the optimal clinical management of LR. Materials and Methods: We conducted a non-randomized, observational, retrospective multicentric registry involving multiple Italian urological centers. We included patients treated with surgery (either nephron-sparing or radical nephrectomy) who later developed LR, defined as recurrence in the ipsilateral kidney or renal fossa. Patients with hereditary syndromes or metastatic disease at the time of LR diagnosis were excluded. Results: We reported 135 cases of LR with the following characteristics: most primary lesions were monofocal (85.7%), with a median size of 42 mm (23\u201353), the median R.E.N.A.L. score was 7 (6\u20138), and the median Padua score was 7 (6\u20139). Patients were treated with robot-assisted techniques in 59% of cases, laparoscopic surgery in 32.4%, and open surgery in 8.6%. Nephron-sparing surgery was performed in 75.2% of cases. Ischemia occurred in 61% of the cases, with a median ischemia time of 21 min (15.5\u201324). Intraoperative complications occurred in 3.8% of cases, while postoperative complications were reported in 13.8%, all of which were grade \u22643 according to the Clavien\u2013Dindo classification. The primary tumors were pT1a in 43.5% of cases, pT1b in 26.3%, pT2 in 14.7% and pT3 in 15.5%. Histologically, 84% of cases were clear cell, 11.3% papillary type 1 or 2, and 3.7% chromophobe. Sarcomatoid\/rhabdoid variants were present in 10.5% of cases. The median rate of LR was 1.3% (range 0.2\u20133.6), while the median time to LR was 18 months (12\u201339). LR occurred in the ipsilateral kidney in 70.5% of cases and in the ipsilateral renal fossa in 29.5%. The median rate of PSM in LR cases at initial surgery was 2.4% (range 0\u20134.3), while the median rate of negative surgical margin (NSM) in LR cases at initial surgery was 0.1 (0\u20130.3). Following LR diagnosis, most patients (49.2%) underwent surgery, 29.1% received cryoablation or radiotherapy, 17.1% received systemic treatment alone, and 4.6% followed a watchful waiting\/active surveillance approach. At a median follow-up of 62 months, the highest oncological control in terms of 5-year cancer-specific survival and overall survival rates was achieved in surgically treated patients. The PSM, the histological variant, and their combination were found to be independent variables correlated with the occurrence of LR, with relative risks of 3.62, 2.71, and 8.12, respectively. Conclusions: LR after nephron-sparing or radical nephrectomy represents a significant clinical dilemma. Known risk factors are not always sufficient to predict recurrence, emphasizing the necessity of consistent radiological follow-up per guideline recommendations. Early detection of recurrence and a multidisciplinary approach involving expert centers are crucial for optimizing patient outcomes.<\/jats:p>","DOI":"10.3390\/cancers17193269","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T13:19:26Z","timestamp":1760015966000},"page":"3269","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Local Recurrence After Nephron Surgery: What to Do? An Italian Multicentric Registry"],"prefix":"10.3390","volume":"17","author":[{"given":"Angelo","family":"Porreca","sequence":"first","affiliation":[{"name":"Department of Urology, Humanitas Gavazzeni, 24125 Bergamo, Italy"},{"name":"Medicine and Surgery, Humanitas University, Pieve Emanuele, 20072 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2908-6907","authenticated-orcid":false,"given":"Filippo","family":"Marino","sequence":"additional","affiliation":[{"name":"Department of Urology, Humanitas Gavazzeni, 24125 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"De Marchi","sequence":"additional","affiliation":[{"name":"Department of Urology, Humanitas Gavazzeni, 24125 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Giampaoli","sequence":"additional","affiliation":[{"name":"Department of Urology, Humanitas Gavazzeni, 24125 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6243-4985","authenticated-orcid":false,"given":"Daniele","family":"D\u2019Agostino","sequence":"additional","affiliation":[{"name":"Department of Urology, Humanitas Gavazzeni, 24125 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Simonetti","sequence":"additional","affiliation":[{"name":"Department of Urology, Humanitas Gavazzeni, 24125 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2730-0402","authenticated-orcid":false,"given":"Antonio","family":"Amodeo","sequence":"additional","affiliation":[{"name":"Department of Urology, Veneto Institute of Oncology IOV\u2014IRCCS, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Corsi","sequence":"additional","affiliation":[{"name":"Department of Urology, Veneto Institute of Oncology IOV\u2014IRCCS, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Claps","sequence":"additional","affiliation":[{"name":"Department of Urology, Veneto Institute of Oncology IOV\u2014IRCCS, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7443-8740","authenticated-orcid":false,"given":"Alessandro","family":"Crestani","sequence":"additional","affiliation":[{"name":"Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0260-4601","authenticated-orcid":false,"given":"Riccardo","family":"Bertolo","sequence":"additional","affiliation":[{"name":"Azienda Ospedaliera Universitaria Integrata Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Antonelli","sequence":"additional","affiliation":[{"name":"Azienda Ospedaliera Universitaria Integrata Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1885-4808","authenticated-orcid":false,"given":"Fabrizio","family":"Di Maida","sequence":"additional","affiliation":[{"name":"Azienda Ospedialiero-Universitaria Careggi, 50134 Firenze, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Minervini","sequence":"additional","affiliation":[{"name":"Azienda Ospedialiero-Universitaria Careggi, 50134 Firenze, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Parma","sequence":"additional","affiliation":[{"name":"Azienda Ospedaliera Carlo Poma, 46100 Mantova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Falabella","sequence":"additional","affiliation":[{"name":"Ospedale S. Carlo, 85100 Potenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Zaramella","sequence":"additional","affiliation":[{"name":"Ospedale degli Infermi, 13875 Biella, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9466-3029","authenticated-orcid":false,"given":"Francesco","family":"Greco","sequence":"additional","affiliation":[{"name":"Policlinico San Pietro, Gruppo San Donato, Ponte San Pietro, 24036 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Chiara","family":"Sighinolfi","sequence":"additional","affiliation":[{"name":"Agostino Gemelli University Polyclinic, 00136 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernardo","family":"Rocco","sequence":"additional","affiliation":[{"name":"Agostino Gemelli University Polyclinic, 00136 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6846-079X","authenticated-orcid":false,"given":"Carmine","family":"Sciorio","sequence":"additional","affiliation":[{"name":"Clinica San Martino, 23864 Lecco, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Celia","sequence":"additional","affiliation":[{"name":"Ospedale San Bassiano, 36061 Bassano del Grappa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5965-9509","authenticated-orcid":false,"given":"Francesca Romana","family":"Prusciano","sequence":"additional","affiliation":[{"name":"Ospedale SS. Annunziata, 74121 Taranto, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6321-946X","authenticated-orcid":false,"given":"Pier Paolo","family":"Prontera","sequence":"additional","affiliation":[{"name":"Ospedale SS. 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