Salvage therapies for local recurrence of renal cell carcinoma: a systematic review and meta-analysis.

We aimed to systematically summarize data on efficacy of local salvage therapies for local recurrence of renal cell carcinoma (RCC). We searched MEDLINE, Embase, Web of Science, CENTRAL, and Google Scholar through 05/08/2026, for studies on local salvage therapies for local recurrence of RCC following radical nephrectomy, partial nephrectomy, or ablation (PROSPERO: CRD42024623099). Meta-analyses were conducted using random-effects models. Risk of bias (RoB) was assessed using ROBINS-I. Forty-seven studies comprising 2039 patients were included (45 retrospective). Patients recurring after primary ablation predominantly presented with new renal masses, and were managed with repeat ablation (6 studies, n = 193) or salvage surgery (3 studies, n = 48), both yielding low recurrence rates. Local recurrences (M0) after primary partial nephrectomy (PN), most often in patients with pT1 disease, were treated with repeat PN, radical nephrectomy (RN), or ablation (15 studies, n = 562), with heterogeneous outcomes across modalities, ranging from low recurrence rates to predominantly distant metastatic failure. In contrast, recurrences after primary RN (12 studies, n = 564) occurred in a population with primarily locally advanced disease (pT3-4) and outcomes were notably worse, driven by distant progression. Four studies used radiotherapy in salvage setting, with heterogeneous methods and outcomes. Majority of studies were assessed moderate RoB, 16 studies assessed as serious, predominantly due to bias in participant selection. Efficacy of local salvage therapies for RCC recurrence is influenced by the primary treatment and histopathological advancement of primary disease. Repeat ablation provides favorable outcomes, while recurrences after PN can be managed with repeat surgery or ablation, with heterogeneous results (from low recurrence rates to frequent distant metastases). Post-RN patients, often with initially advanced disease, have worse prognosis with approximately two-thirds experiencing progression by three years, primarily due to distant metastases. Overall, quality of evidence remains low. There is critical need for expert consensus on quality indicators for locally recurrent RCC care and for prospective registries with standardized outcome reporting.