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Surveillance - After Nephrectomy

Clear cell, renal cell carcinoma (ccRCC) patient's that have a partial or radical nephrectomy are usually followed up under a surveillance program based on their individual case. 

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General guidelines, such as those outlined by Dr. Brad Liebovich, Mayo Clinic, serve as recommendations for physicians to follow patients who have had a nephrectomy, monitoring the patient for any recurrence of renal cancer.  Dr. Liebovich and his team developed the Progression-Free Survival Score to classify patient's as low, medium, and high risk for recurrence. 

Surveillance

Patient Classification*

The Liebovich Model recommends imaging / follow up for all patient classifications at 3 months post-surgery to check for recurrence as well as establish a new baseline for the patient for comparison against future imaging / testing. The higher the risk a patient is for recurrence, the more frequent are the intervals for ongoing testing.

Stage I and II
(Low Risk)

3 months post op

  • CT or MRI with contrast of abdomen

  • Chest x-ray

  • Basic Metabolic Panel (BMP)

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then,

Annually for 5 years after surgery

  • (same testing as above)

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then,

> 5 years

  • Renal ultrasound

  • Chest x-ray at clinical discretion

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Stage III
(Intermediate Risk)

3 months post op

  • CT or MRI with contrast of abdomen/pelvis

  • Chest x-ray or CT

  • Basic Metabolic Panel (BMP)

​​

then,

6 month intervals for 3 years

  • (same testing as above)

 

then,

>3 years - Annually

  • (same testing as above)

 

then,

> 5 years - Patient Specific 

  • ​​Based on individual patient's case / history​​

Stage IV
(High Risk)

3 months post op

  • CT or MRI with contrast of abdomen/pelvis

  • Chest x-ray or CT

  • Basic Metabolic Panel (BMP)

​​

then,

4 month intervals for 2 years

  • (same testing as above)

 

then,

>2 years at 6 month intervals (years 3 to 5 after surgery)

  • (same testing as above)

 

then,

> 5 years - Annually 

  • (same testing as above)​​

*Based on published Mayo Clinic risk score (Liebovich BC, Cancer 2003;97:1663-1671)

National Comprehensive Cancer Network
Kidney Cancer Guidelines

NCCN Guidelines

The National Comprehensive Cancer Network (NCCN) is a not-for-profit alliance of 33 leading cancer centers devoted to patient care, research, and education.

  

The NCCN develops resources that present valuable information to stakeholders in health care. Part of their mission is creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers.  One of the guidelines is the recommended treatment for patients with kidney cancer. 

 

The most recent Kidney Cancer Treatment Guidelines (March 2025) can be viewed on the NCCN website in pdf format.  These guidelines are detailed and extensive.  Well worth your time and attention if you want to understand the details of the management and treatment guidelines for kidney cancer at all stages.

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An important note is that the guidelines are just that - guidelines.  No single follow-up plan is appropriate (fits) all patients.  Management should be individualized based on each patient's unique medical condition and other contributing factors.

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