Renal cell carcinoma is a frequent and aggressive tumor entity. Oncological follow-up is of major concern as local and contralateral recurrence occurs (1.2% and 1.8% respectively) . Early detection of recurrence is of utmost importance as cytoreductive surgery is the key for successful treatment [12, 13]. Surprisingly there is no consensus on the ideal postoperative surveillance strategy . To assess the risk of either local or contralateral recurrence several prognostic factors were identified and scoring systems and algorithms were developed [14–17]. Despite the reliable prediction of recurrence in a defined cohort of patients (e. g. patients treated at the University of California at Los Angeles) these nomograms have not gained wide acceptance in Germany .
To define the ideal follow-up modality it is essential to know time and localization of recurrence and to adapt the imaging modalities accordingly. Larger autopsy studies have shown that even clinically undetected RCC spreads to lung (2 - 14%), bone (1 - 7.6%) and liver (0 - 7.4%) [19–21]. Therefore these locations have to be monitored closely during follow up. For small tumors the risk of recurrence seems to be independent of radical or organ sparing surgery [12, 19, 22, 23]. Therefore the EAU guidelines suggest rather a risk stratification by histopathological factors like grading, pathological stage and lymph node status than the type of surgery performed . In low-risk patients routine CT scans are not recommended except in cases of possible tumour associated symptoms (weight loss, haematuria, painful bones). Only for intermediate and high-risk patients close follow up by CT scans might be indicated.
Besides the most likely location of recurrent disease, the average time until recurrence is decisive for follow-up recommendations. According to the Mayo Scoring system  recurrence in the first year occurs in patients with low-risk, intermediate-risk and high-risk in 0.5, 9.6 and 42.3%, respectively. After 5 years the recurrence rate raises up to 2.9, 26.2 and 68.8%, respectively. As most recurrence occur within 5 years after first diagnosis close follow-up might be omitted after this time .
To the best of our knowledge there is no study investigating the follow-up modalities of patients with renal cell carcinoma in Germany. Neither it is known if patients prefer follow-up examinations by their urologist or general practitioner and how closely patients are followed up.
In our cohort, in 72% of patients were examined by their urologist, followed by general practitioners (20%) and nephrologists (9%). This distribution might be due to the specific health system in Germany in which general practitioners play the central role in referring oncologic patients to specialists (e. g. urologists). Many patients obviously tend to undergo follow-up at the doctor who actually diagnosed the tumor. As ultrasound is broadly available in developed countries a considerable number of tumors are detected during routine check-up examinations by general practitioners.
The types of technical examinations were the same for patients after ORN and NSS. In 96% ultrasound was used, laboratory controls of urine and blood were used in more than 80%. CT scans of abdomen and chest were used in 64% respectively 29% of patients. This is in line with most follow-up recommendations suggesting CT scans every 6 months for 2 years for intermediate- and high-risk patients. CT scans of head (5%) or abdominal MRI (9%) were limited to selected cases or indications as suggested by the EAU.
Interestingly there were significant differences in the examination modalities employed between urologists and non-urologist health professionals. Urologists applied all of them more often with the largest discrepancy for imaging modalities. This might be an indication that urologist more often stick to guideline recommendations by urological associations.
Nearly two thirds of patients were followed every three months, which seems to be a reasonable interval . On the other hand up to 9% of patients were not under surveillance at all, indicating the need of a better patient education.
Only a small proportion of patients (13 - 18%) was asking for psycho-oncological support. It is known from larger studies that up to 41% of patients with tumor disease are in need of professional psycho-oncological support . The discrepancy might be due to a low tumor stage (most of them T1) in our patients contributing to better well being compared to other studies. As many patients might benefit of psycho-oncological support, it should be routinely and actively offered during hospital stay.