Guideline of guidelines: follow-up after nephrectomy for renal cell carcinoma Timothy J. Williamson*, John R. Pearson*, Joseph Ischia*, Damien M. Bolton* and Nathan Lawrentschuk* ,†,‡ *Department of Surgery, Austin Hospital, University of Melbourne, † Division of Cancer Surgery, Peter MacCallum Cancer Centre, and ‡ Olivia Newton-John Cancer Research Institute, Austin Hospital, Melbourne, Vic., Australia The purpose of this article was to review and compare the international guidelines and surveillance protocols for post- nephrectomy renal cell carcinoma (RCC). PubMed database searches were conducted, according to the PRISMA statement for reporting systematic reviews, to identify current international surveillance guidelines and surveillance protocols for surgically treated and clinically localized RCC. A total of 17 articles were reviewed. These included three articles on urological guidelines, three on oncological guidelines and 11 on proposed strategies. Guidelines and strategies varied significantly in relation to follow-up, specifically with regard to the frequency and timing of radiological imaging. Although there is currently no consensus within the literature regarding surveillance protocols, various guidelines and strategies have been developed using both patient and tumour characteristics. Keywords kidney neoplasms, nephrectomy, guideline, recurrence, outcomes Introduction Worldwide the incidence of renal cell carcinoma at all stages is increasing and contributes 3% of all new adult malignancies [1,2]. Curative treatment with surgical resection, either nephron-sparing or radical, is the mainstay of treatment for clinically localized disease, with reported recurrence rates being between 20 and 30% [3]. These high rates of recurrence, combined with the necessity for early detection to increase the chance of favourable outcomes, underscore the importance of post-treatment surveillance. The development of follow-up guidelines endorsed by several respected organizations has been achieved through comprehensive reviews of the literature. As with most malignancies, surveillance protocols after surgical resection of the primary tumour focus on the identification of three key outcomes: oncological control, functional preservation and survivorship. Understanding the natural history of kidney neoplasms as well as the chronology, sites and prognostic indicators of tumour recurrence help predict the likelihood and timing of disease relapse. Functional outcomes after nephrectomy are measured largely by the preservation of renal function as well as the development of postoperative sequelae. Survivorship encompasses both the physical wellbeing of the patient as well as the psychosocial impact of treatment and follow-up. Finally, understanding the different methods of detecting disease recurrence, and their risks and benefits, is important when planning follow-up, with significant resource implications for the healthcare system. Currently, there are no agreed upon follow-up guidelines in many jurisdictions, and it is the aim of the present review to compare the current international guidelines available in the literature. The American Urological Association (AUA) released a comprehensive set of guidelines in 2013 [4]. The European Association of Urology (EAU) released a full-text update of their RCC guidelines in 2013, with a partial update in 2014 [5], the Canadian Urological Association (CUA) released guidelines in 2008, with the most recent consensus update in 2011 [6] and the National Comprehensive Cancer Network (NCCN) released guidelines in 2014, with an update in early 2015 [7]. In presenting this review, we hope to distil the information and bring consensus to follow-up of patients undergoing nephrectomy. Methods A systematic review was conducted in March 2015, with an update in October 2015, based on the guidelines outlined by the PRISMA statement for reporting systematic reviews [8]. Using the PubMed database and synonyms for the search terms ‘renal cell carcinoma’, ‘follow-up’ and ‘guidelines’, articles were identified pertaining to post-nephrectomy surveillance for localized disease. Articles regarding advanced © 2015 The Authors BJU International © 2015 BJU International | doi:10.1111/bju.13384 BJU Int 2016; 117: 555–562 Published by John Wiley & Sons Ltd. www.bjui.org wileyonlinelibrary.com Guidelines