What are the important considerations for resection of a local recurrence of RCC?
Locally recurrent tumors after radical nephrectomy not constrained by the usual anatomic barriers and invasion of adjacent organs is more common. Hence en bloc resection of adjacent organs is often required and may require hemicolectomy, distal pancreatectomy, partial hepatectomy, etc. In this case the relevant issues are possible need for resection of part or a segment of the IVC with concomitant reconstruction, and possible need for partial hepatectomy. These cases typically require an open surgical approach, and in this case involvement of a colleague with expertise in liver transplantation should be considered to help mobilize the liver and facilitate isolation of the upper IVC. In addition, partial hepatectomy may be required.