Postoperative Surveillance Protocols for Renal Cell Carcinoma

Patients with renal cell carcinoma (RCC) are at risk of recurrence even after definitive surgical extirpation. Without prompt identification and treatment of recurrent disease, prognosis is poor. Literature suggests that early intervention in the form of metastasectomy and/or targeted therapy can lead to prolonged survival in those who develop recurrent or metastatic RCC. Therefore, surveillance in the postoperative setting is of paramount importance. Currently, there is no single consensus on the optimal surveillance strategy following radical or partial nephrectomy or ablative therapies used to treat RCC. The purpose of this chapter is to provide a comprehensive review of the existing data on postoperative surveillance strategies, and how prognostic factors and patterns of recurrence have contributed to the establishment of such protocols. The specific components of surveillance are described, and several evidence-based recommendations are reviewed, including the most recent AUA guidelines (2021), the 2024 National Comprehensive Cancer Network (NCCN) guidelines, the European Association of Urology Renal Cell Cancer Guidelines (revised 2022), the Canadian Urological Association Guidelines (2018), and a surveillance algorithm based on the UCLA-Integrated Scoring System (UISS). Briefly, frontiers in surveillance are also discussed, such as the incorporation of molecular biomarkers into existing surveillance models.