To explore the clinical features of local recurrence after partial nephrectomy for renal cancer, and compare the prognosis of surgery and targeted drug therapy.

The medical records and follow-up data of 19 renal cancer patients who had local recurrence after partial nephrectomy in Renmin Hospital of Wuhan University from January 2006 to December 2019 were analyzed retrospectively. There were 10 males and 9 females, the median age was 55(28-72) years. The median time between patients' first recurrence was 18(3-54) months. There were 6 cases in pT_1a stage, 12 cases in pT_1b stage, 1 case in T₂ stage. 5 cases in Fuhrman grade I-II, 10 cases in grade III, and 4 cases in grade IV. Primary surgical approach: 12 cases underwent laparoscopy, 7 cases open surgery. Secondary treatment: surgery + targeted drug therapy in 11 cases, and only targeted drug therapy in 8 cases. Laparoscopy was performed in 3 cases, open surgery in 8 cases; repeated partial nephrectomy in 2 cases, and radical nephrectomy in 9 cases.

The recurrence rate of partial nephrectomy was 2.2% (19/875) for the first time and 36.4% (4/11) for the second time. In this study, the median operation time of 11 patients with secondary operations was 215 (105-270) minutes. The median bleeding volume was 270 (100-1 800) ml. Postoperative complications occurred in 5 cases of grade I and 3 cases of grade II, which improved after treatment. 13 patients (68.4%) experienced sunitinib side effects, which were improved after treatment. The median follow-up time of 19 patients was 24(3-54) months, 3 cases were lost to follow-up, and 5 cases died. The 1-year progression-free survival rate (PFS) of patients in the targeted drug therapy group was 62.5%, and that in the surgery + targeted drug therapy group was 81.9%; the 3-year progression-free survival rates of the two groups were 31.2% and 40.0%, respectively. The median progression-free survival in the surgery + targeted drug treatment group was 36 months, which was longer than the mPFS of the surgery alone group at 18 months. There was no statistically significant difference in total PFS between the two (P=0.256).

Patients with local recurrence of renal cancer after partial nephrectomy can choose targeted or surgical treatment. Compared with targeted therapy, surgery + targeted comprehensive treatment does not achieve significant survival benefits for patients, which requires careful consideration.