Classification of positive surgical margins and tumor recurrence after nephron-sparing surgery for small renal masses

Abstract

BackgroundThe association of positive margin and local recurrence after nephron-sparing surgery (NSS) remains a notably controversial issue. The aim of the present study was to investigate the relationship between classification of positive surgical margins (PSMs) and tumor recurrence based pathological findings.MethodsClinical, pathological, and follow-up data of 600 small renal cancer patients who underwent NSS between November 2007 and November 2017 at four hospitals in China were analyzed retrospectively.ResultsOf the 600 reviewed patients, 20 had positive margins. During the follow-up period of 56 months, only three cases of tumor recurrence were identified. Pathological examination was performed, and subsequently a new classification criteria were proposed: 1) False PSMs, which could be further divided into three subtypes: i) no standard processing performed on pathological specimens (seven patients); ii) incidental incision into the tumor during operation, with the tumor bed free of tumor residues (four patients); iii) part of the tumor pseudocapsule was noted to be remained in the tumor bed, with no signs of tumor residue (four patients). 2) True PSMs with two subtypes: i) a large number of residual tumor cells at the surgical margin (three patients); ii) incision of satellite tumor nodules detected around a large tumor (two patients).ConclusionTaken together, PSMs in NSS were rarely found. Based on the pathological examination findings, PSMs can be divided into false positive and true positive. This being said, PSMs were determined to be poor predictors for local recurrence, with no predominant association with true tumor remnants in the majority of our evaluated cases. Through the key findings of our study, we concluded that PSMs should be carefully analyzed and treated on a case-by-case basis.

Positive surgical margins may not affect the survival of patients with renal cell carcinoma after partial nephrectomy: A meta-analysis based on 39 studies

“…Twenty studies provided comparative data on tumor metastasis between the two groups ( 4 , 6 , 13 – 15 , 17 , 18 , 20 , 25 , 27 , 30 , 33 – 36 , 38 , 40 – 43 ), including 434 patients in the PSM group and 8298 patients in the NSM group. In 4 studies ( 13 , 14 , 35 , 36 ), the number of metastatic cases in the two groups was zero, and the OR value could not be calculated. Pooled data showed a significantly higher rate of metastasis in the PSM group (OR 4.63, 95% CI 3.11-6.88; p < 0.00001), and similar results could be observed in subgroup analyses ( Figure 3 ).…”

Nefrectomía parcial vs enucleación tumoral

“…En una revisión sistemática se comprobó que aquellos pacientes sometidos a enucleación pasaron menos tiempo ingresados. (55) Como ya se ha comentado previamente, la cirugía conservadora de nefronas se ha estandarizado como tratamiento habitual de las masas renales de pequeño tamaño. Con el paso de los años, se han desarrollado nuevas técnicas como enucleación simple, que atiende solo a la masa tumoral y a preservar el parénquima sano.…”

Surgical margins after partial nephrectomy as prognostic factor for the risk of local recurrence in pT1 RCC: a systematic review and narrative synthesis

“…[ 15 ] RC OPN and RAPN 2.3 + 0.8/2.2 + 0.8 (mean + SD) 48.3 (median) 702 1.6% 0% 0.3% 3 Li et al . [ 16 ] RC OPN and LPN NR 56 (median) 600 3.3% 0% 0.2% 4 Marchiñena et al . [ 17 ] RC OPN, LPN and RAPN 2.9 (2.1–3.8) (median (IQR)) 24 (12–40) median (IQR)) 314 7% 9.1% 1.4% 5 Minervini et al .…”

“…[ 15 ] Malignant cells being present at the inked parenchymal surgical margin of resection on the final pathology assessment Tumor bed recurrence CT abdomen, blood test and chest x-ray at 3 months, 12 months and annually thereafter 3 Li et al . [ 16 ] Large number of residual tumor cells at the surgical margin OR incision of satellite tumor nodules around the large tumor In situ recurrence The follow-up was specific to each institution’s practice with a physical examination and a CT scan of the abdomen usually included 4 Marchiñena et al . [ 17 ] Tumor cell that contacted with Chinese ink Tumor mass in the ipsilateral kidney over the resection bed of the same histological type of the original tumor The oncologic follow-up was performed according to the NCCN guidelines 5 Minervini et al .…”