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Few reports have described port site tumor recurrence following laparoscopic or retroperitoneoscopic radical nephrectomy for renal cell carcinoma. We report a case in which recurrence in the lumbar musculature developed 39 months after retroperitoneoscopic radical nephrectomy. CASE REPORT A 56-year-old male who had been maintained on hemodialysis for 6 years due to chronic renal failure (CRF) had a 6 cm solid mass discovered incidentally on ultrasonography of the left kidney. Computerized tomography (CT) revealed a 5 6 cm solid tumor arising in an atrophic kidney (fig. 1). Findings were consistent with stage T1bN0M0 renal cell carcinoma. The patient underwent retroperitoneoscopic radical nephrectomy via a posterior lumbar approach as described previously. 1 The kidney was evacuated though a posterior skin incision without using an organ entrapment sac. Pathological examination showed grade 2, pT3a clear cell carcinoma of the kidney. The margin was negative for malignant cells. At 39 months postoperatively the patient presented complaining of left lumbar pain around the operation scar. CT demonstrated an enhancing tumor in the lumbar muscles along the evacuation route of the kidney (fig. 2). Needle biopsy followed by pathological examination revealed metastatic renal cell carcinoma. Since the patient refused surgical resection, radiation therapy was administered to control the local symptoms. DISCUSSION