Histopathologic analysis of stage pT1b kidney neoplasms for optimal surgical margins of nephron-sparing surgery

Abstract

ObjectiveTo evaluate the pathological features and define the optimal surgical margins (SM) of nephron-sparing surgery (NSS) for kidney neoplasms 4–7 cm (stage pT1b) on preoperative imaging.Materials and methodsThe retrospective study included 748 patients who were diagnosed stage pT1b renal tumors and underwent either radical nephrectomy (RN, n = 475) or NSS (n = 273) from January 2004 to March 2017. The tumor size, pathological subtype, Fuhrman grade, status of peritumoral pseudocapsule (PC) and tumor multifocality were recorded. The relationship between peritumoral PC and positive SM was calculated statistically by Fisher’s exact probability test.ResultsThe mean tumor diameter was 5.4 cm (range: 4.1–7.0 cm), 65 (8.7%) cases were discovered with multifocal lesions and 686 (91.7%) were surrounded with peritumoral PC in all 748 specimens. 57 (8.3%) of 686 cases were proved with tumor infiltrated beyond PC [infiltration (+)], and the presence of PC infiltration (+) was significantly correlated with positive SM (p = 0.016). The infiltrative depth of tumor cells into renal parenchyma beyond PC was all limited in 3 mm and the proportion of ≤ 1, 1–2 and 2–3 mm was 21.1% (12/57), 59.6% (34/57) and 19.3% (11/57), respectively.ConclusionsOur report indicates a 3 mm excisional margin is acceptable to ensure negative SM when operating NSS on stage pT1b kidney neoplasms.

The Correlation of Clinicopathological Features With the Status of Surgical Margins in Renal Cell Cancer Patients Following Nephron-Sparing Surgery: A Systematic Review and Meta-Analysis

“…To our knowledge, this is one of the largest meta-analyses evaluating the predictors of PSMs. Traditionally, the occurrence of PSMs after NSS was considered to be related to the nature of the RCC and the surgical procedure (37–39). In the current study, PSMs were statistically associated with Furhman grade (3–4 vs. 1–2), pathologic stage (3–4 vs. 1–2), non-ccRCC histology, and non-white race.…”

Efficacy of povidone-iodine against accidental tumor incision during nephron-sparing surgery: experimental study in patients with renal cell carcinoma

“…5 A prior study found that the rate of tumor seeding and metastasis can be effectively reduced by avoiding tumor incisions. 6 However, accidental tumor incision (ATI) occasionally occurs in patients treated with NSS and is associated with tumor recurrence and metastasis. 7 To investigate the risk factors for tumor recurrence and metastases associated with ATI, we collected data from pT1N0M0 RCC patients who underwent NSS between 2010 and 2015.…”