Long-term oncologic outcomes of positive surgical margins following robot-assisted partial nephrectomy

Abstract

Background: Previous reports on positive surgical margin (PSM) after robot-assisted partial nephrectomy (RAPN) have reached inconsistent conclusions as to the impact of a PSM on oncologic outcomes. We sought to determine the effect of PSM on long-term cancer recurrence and survival outcomes. Methods: We queried our renal oncology database for patients having undergone RAPN and compared recurrence-free survival (RFS) and overall survival (OS) between patients with PSM and negative surgical margin (NSM). Kaplan-Meier analysis was also performed for RFS and OS for PSM versus NSM. Results: Of the 432 patients who underwent RAPN we identified 29 (6.7%) patients with PSM and 403 (93.3%) patients with NSM. Median follow-up for the overall cohort was 45.1 months. Three of the 29 patients with PSM and fourteen of the 403 patients with NSM had disease recurrence (P=0.09).RFS at 24, 48, and 72 months was 95.8%, 90%, and 85.5% for patients with NSM and 96.6%, 86.6%, and 80.4% for patients with PSM, respectively (log-rank P value =0.382). OS at 24, 48, and 72 months was 98%, 93.1%, and 89.7% for patients with NSM and 96.3%, 91.2%, and 85.2% for patients with PSM, respectively (log-rank P value =0.584).Conclusions: While PSM are relatively uncommon, their presence still serves as a potential risk factor for worse oncologic outcomes. In instances of PSM, immediate secondary intervention is most likely unnecessary and more attentive long-term clinical follow-up, especially in patients with high-risk features, may be more advisable.

Robot‐assisted partial nephrectomy for high‐complexity tumors (PADUA score ≥10): Perioperative, long‐term functional and oncologic outcomes

“…25 Another retrospective study did not show an association between PSM and worse oncologic outcomes in terms of RFS and OS, concluding that a longer and more intense follow up in patients with PSM could be a valuable strategy. 22 This is consistent with the present analysis, as the higher rate of PSM in patients with a PADUA score of 12-13 did not reflect on differences in RFS and OS when compared with the other two groups of PADUA score using the Kaplan-Meier method. Furthermore, only one out of seven patients of the present cohort who experienced a recurrence had PSM (Table S1).…”

“…Regarding margin status, a PSM was identified in 10.5% of the specimens with malignancy in final pathology, which is attributed to the significantly higher PSM rate observed in patients with a PADUA score of 12-13 (P = 0.017), whereas the rates of PSM in the PADUA 10 and PADUA 11 groups were comparable to that reported in previous series of RAPN. 22,23 In a multicenter observational study of 399 patients who underwent RAPN for cT1 renal masses, the reported PSM rate was 6.5%; when the results were divided by PADUA classification, the rate of PSM was 11.5% in patients with a high-complexity tumor (PADUA score ≥10). 23 From the oncological standpoint, the effect of PSM in patients treated with PN in recurrence and survival rates is still conflicting.…”

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

“…We extracted data on local recurrence in two groups from 33 studies ( 4 , 6 , 11 – 15 , 17 – 23 , 25 – 30 , 32 – 38 , 40 – 45 ) including 13473 patients (PSM: 785, NSM: 12688). In 8 studies ( 13 , 14 , 18 – 21 , 36 , 38 ), the OR value could not be calculated because the number of local recurrence was zero in both the PSM and NSM groups.…”

“…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.…”

Nefrectomía parcial robótica en tumores Ó� 3 cm. Complicaciones y resultados funcionales y oncológicos a largo plazo

“…Ninguno de nuestros pacientes con margen quirúrgico positivo presentó recidiva local, metástasis a distancia ni mortalidad específica de cáncer durante el seguimiento. Por lo tanto, nuestros resultados concuerdan con aquellos que indican que el estado y el tamaño del margen no están asociados con la recurrencia (local o distancia) ni con la mortalidad [38][39][40] .…”