Is a 1-cm margin necessary during nephron-sparing surgery for renal cell carcinoma?

Piper, Natania Y.; Bishoff, Jay T.; Magee, Christopher; Haffron, Jason M; Flanigan, Robert C.; Mintiens, Annemieke; Poppel, H. P. Van; Thompson, Ian M.; Harmon, William J.

doi:10.1016/s0090-4295(01)01393-0

Cited by 90 publications

(34 citation statements)

References 14 publications

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“…Nevertheless, in recent years there have been several reports on the reduction of the thickness of the safety margins that should be excised with the tumor to avoid the risk of local recurrence. Others have recently gone further, concluding that, if the tumor is completely excised, the width of the resection margin is irrelevant and not correlated with disease progression, thus providing an intriguing insight into the real need to excise an adequate rim of healthy kidney tissue around the tumor [11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Histopathologic Analysis of Peritumoral Pseudocapsule and Surgical Margin Status after Tumor Enucleation for Renal Cell Carcinoma

et al. 2009

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Section: Introductionmentioning

confidence: 99%

Histopathologic Analysis of Peritumoral Pseudocapsule and Surgical Margin Status after Tumor Enucleation for Renal Cell Carcinoma

et al. 2009

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“…Intraoperative biopsy of the tumor bed was never performed but no positive margin was present at final pathologic examination. This might be due simply to serendipity, but also in other series the positive margin rate was very low, varying from 0 [13] to 10.4% [21], and it has never been demonstrated that biopsy of the tumor bed may decrease the positive margin rate. Indeed, technically, it is not easy and, if performed extensively, may increase the chance of complication.…”

Section: Discussionmentioning

confidence: 88%

“…Li et al [20] concluded that when partial nephrectomy is performed, a 5-mm margin is sufficient enough to prevent a possible local recurrence. Piper et al [21] reported a multicenter review study of 67 patients who underwent NSS. They found that the 49 patients treated with NSS and margins greater than 1 mm were alive and free from local recurrence and distant metastases at a mean follow up of 50 months.…”

Section: Discussionmentioning

confidence: 99%

Enucleoresection for the Elective Treatment of Small Renal Cell Carcinoma: Can It Be the Treatment of Choice?

Adamakis¹,

Koutalellis²,

Mitropoulos³

et al. 2007

Oncol Res Treat

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Background: We present our findings in a series of T1 renal cell carcinomas (RCC) treated with excision of the tumor surrounded by a minimal layer of grossly normal parenchyma. Patients and Methods: A total of 43 patients who underwent elective nephron-sparing surgery performed with enucleoresection were studied retrospectively. None of the patients had preoperative or intraoperative suspicion of positive nodes and were free from distant metastases before surgery (N0, M0). Patients status was last evaluated in January 2006. Results: Median age was 58.7 years (35-78). Median tumor size was 3.3 cm (1.5-7). There were no major complications such as bleeding and urinary leakage/ urinoma requiring re-operation. Pathological stage was pT1a in 38 (89%), pT1b in 4 (9%) and pT3a in 1 (2%) patient. Median followup was 32 months (6-89). A total of 5 patients with RCC had died as of January 2006. Overall, 3 (6.9%) patients had disease progression, of whom 2 (4.6%) were local recurrence, 1 alone and 1 associated with distant metastases. The overall cancer-specific survival was 95.4%, and the overall progression-free survival was 93%. Conclusions: Enucleoresection reproduces the results of partial and radical nephrectomy with minimal morbidity. It is a safe and acceptable approach for elective nephronsparing surgery.

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“…21 However, with the expansion of indications to larger and centrally located tumors, wider safety margins were no always technically feasible, and simple tumor enucleation has been proposed as an alternative. 22,23 In a retrospective review by Carini et al, 24 71 patients with renal cortical tumors between 4 and 7 cm were treated by simple enucleation of the tumor and followed with a median follow-up of 51 months; the 5-and 8-year cancer specific survival rates were 85.1% and 81.6%, respectively. The local recurrence rate, however, was 4.5%; the histologic distribution in this series was 85.9% clear cell, 8.5% chromophobe, and 5.6% papillary.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Partial Nephrectomy for Renal Tumors >4 cm: Comparison With Renal Tumors ≤4 cm

Kwon

Byun

Hong

et al. 2016

International Surgery

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Partial nephrectomy has become a treatment of choice for clinical T1a renal masses. Some international guidelines suggest that partial nephrectomy can be applied also in clinical T1b tumors. The aim of this study was to evaluate the feasibility of partial nephrectomy for tumors larger than 4 cm. We reviewed the medical records of 1280 patients who underwent partial nephrectomy and had pathologically confirmed malignancy. Patients were categorized into two groups by the size of tumors on computed tomography image, with a cutoff value of 4 cm. The oncologic and functional outcomes were compared between the two groups. Recurrence-free survival after surgery was estimated using the Kaplan-Meier method. Of the 1280 patients, 203 patients (15.9%) had renal tumors larger than 4 cm. There were significantly more exophytic tumors (P , 0.001) and the R.E.N.A.L. scores were significantly higher (P , 0.001) in partial nephrectomy .4 cm. Mean ischemic times were significantly different (P , 0.001). After 24 months, mean creatinine level between partial nephrectomy .4 cm and partial nephrectomy 4 cm was not different significantly (P ¼ 0.554). And the percent changes of glomerular filtration rate after partial nephrectomy were not different at last follow-up (P ¼ 0.082). The 5-year recurrence-free survival rates were 96.6% in partial nephrectomy 4 cm, and 94.5% in partial nephrectomy .4 cm (P ¼ 0.416). Based on the present findings, partial nephrectomy for tumors larger than 4 cm showed comparable feasibility and safety to partial nephrectomy for tumors 4 cm considering oncologic and functional outcomes, despite longer operative and ischemic time. Key words: Glomerular filtration rate -Kidney neoplasms -Nephrectomy -Partial -Size H istorically, radical nephrectomy has been established as the standard treatment for localized renal cell carcinoma.1 Renal cancer does not represent a single disease, but a compendium of a complex family of tumors, with variable metastatic potential ranging from benign tumor to clear cell carcinoma.2 Therefore, the rationale of radical nephrectomy for 20% to 30% of patients with benign or low malignant potential renal tumors has been questioned. Partial nephrectomy (PN), or nephronsparing surgery, has become a treatment of choice for clinical T1a renal masses and has been shown to provide comparable oncologic outcomes.3 In addition, PN offers lower renal function impairment compared with radical nephrectomy. 4 As a result, the prevention of chronic kidney disease possibly helps to obtain a better overall survival, and constitutes a wider use of PN. And some international guidelines suggest that PN can be applied also in clinical T1b tumors. 5,6 The European Association of Urology guidelines have recommended PN as an alternative treatment for single renal mass larger than 4 cm, if possible. 5 The American Urological Association guidelines have suggested that PN could be helpful for T1b tumors in patients whose renal function needs to be preserved. 6 Furthermore, a recent study was reported providing...

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Is a 1-cm margin necessary during nephron-sparing surgery for renal cell carcinoma?

Cited by 90 publications

References 14 publications

Histopathologic Analysis of Peritumoral Pseudocapsule and Surgical Margin Status after Tumor Enucleation for Renal Cell Carcinoma

Histopathologic Analysis of Peritumoral Pseudocapsule and Surgical Margin Status after Tumor Enucleation for Renal Cell Carcinoma

Enucleoresection for the Elective Treatment of Small Renal Cell Carcinoma: Can It Be the Treatment of Choice?

Efficacy of Partial Nephrectomy for Renal Tumors >4 cm: Comparison With Renal Tumors ≤4 cm

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Is a 1-cm margin necessary during nephron-sparing surgery for renal cell carcinoma?

Cited by 90 publications

References 14 publications

Histopathologic Analysis of Peritumoral Pseudocapsule and Surgical Margin Status after Tumor Enucleation for Renal Cell Carcinoma

Histopathologic Analysis of Peritumoral Pseudocapsule and Surgical Margin Status after Tumor Enucleation for Renal Cell Carcinoma

Enucleoresection for the Elective Treatment of Small Renal Cell Carcinoma: Can It Be the Treatment of Choice?

Efficacy of Partial Nephrectomy for Renal Tumors &gt;4 cm: Comparison With Renal Tumors ≤4 cm

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Efficacy of Partial Nephrectomy for Renal Tumors >4 cm: Comparison With Renal Tumors ≤4 cm