Positive Surgical Margin Appears to Have Negligible Impact on Survival of Renal Cell Carcinomas Treated by Nephron-Sparing Surgery

Bensalah, Karim; Pantuck, Allan J.; Rioux‐Leclercq, Nathalie; Thuret, Rodolphe; Montorsi, Francesco; Karakiewicz, Pierre I.; Mottet, Nicolas; Zini, Luca; Bertini, Roberto; Salomon, Laurent; Villers, Arnauld; Soulié, M.; Bellec, L.; Rischmann, P.; Taille, Alexandre de la; Авакян, Р.; Crépel, Maxime; Ferrière, J.; Bernhard, Jean-Christophe; Dujardin, Thierry; Pouliot, Frédéric; Rigaud, J.; Pfister, Christian; Albouy, Baptiste; Guy, Laurent; Joniau, Steven; Poppel, Hendrik Van; Lebrét, Thierry; Culty, T.; Saint, F.; Zisman, Amnon; Raz, Orit E.; Lang, Hervé; Spie, R.; Wille, Andreas; Roigas, Jan; Aguilera, Alfredo; Rambeaud, Bastien; Piñeiro, Luis Martínez; Nativ, Ofer; Farfara, Roy; Richard, François; Rouprêt, Morgan; Doehn, Christian; Bastian, Patrick J.; Müller, Stefan; Tostain, Jacques; Belldegrun, Arie S.; Patard, Jean Jacques

doi:10.1016/j.eururo.2009.03.048

Cited by 239 publications

(175 citation statements)

References 18 publications

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“…Bensalah et al retrospectively evaluated a cohort of 775 patients treated with PN and found comparable results: a greater frequency of high-grade tumors was found in patients with PSMs rather than in those with NSMs (30% vs. 19.4%, respectively). 12 Contrasting results have been recently reported in other studies, 8 in which nuclear grade was neither associated nor an independent predictor of PSMs.…”

Section: Riccardo Schiavina Et Alcontrasting

confidence: 55%

“…7 In all cases, NSS might result in incomplete cancer removal, thus causing PSMs, which might need additional follow-up and can lead to a potentially increased risk of local recurrence and disease progression. [8][9][10] In the absence of randomized trials providing strong clinical evidence, several factors have been advocated as predictors of PSMs after NSS, such as tumor size, 11 pathological stage, 9 Fuhrman grade, 12 indication for NSS (elective vs. imperative), 11 and surgical volume. 13 Conversely, the surgical approach (open vs. minimally invasive), and surgical technique (standard PN vs.…”

Section: Introductionmentioning

confidence: 99%

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A Prospective, Multicenter Evaluation of Predictive Factors for Positive Surgical Margins After Nephron-Sparing Surgery for Renal Cell Carcinoma: The RECORd1 Italian Project

Schiavina

Serni

Mari

et al. 2015

Clinical Genitourinary Cancer

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The early oncological goal of any partial nephrectomy (PN) is to achieve negative surgical margins (SMs). Several factors have been advocated as predictors of positive SMs (PSMs) after nephron-sparing surgery (NSS). In our study, age, upper pole tumor location, standard PN and Fuhrman 3/4 nuclear grade were found to be independent predictors of PSMs at multivariable analysis. Further evaluations are required to verify the oncological effect of the PSM on local and systemic recurrence. Background: The purpose of this study was to evaluate the predictors of positive margins in one of the largest available prospective multi-institutional studies. Patients and Methods: We evaluated all patients who underwent NSS for radiologically diagnosed kidney tumors between January 2009 and December 2012 at 19 urological Italian centers (Registry of Conservative Renal Surgery [RECORd] project). Preoperative and anthropometric data, comorbidities, intraoperative and postoperative outcomes, and histological findings were analyzed. The negative and PSMs were compared according to the clinical and surgical variables. Multivariable logistic regression models were applied to analyze predictors of PSMs. Results: Eight hundred consecutive patients were evaluated. Seven hundred sixty-one (95.1%) and 39 patients (4.9%) achieved negative and PSMs, respectively. Patients with PSMs were significantly older compared with those with negative margins (median age: 66.6 vs. 61.8 years, respectively; P ¼ .001). A higher incidence of PSMs was observed when NSS was performed for renal masses located in the upper pole (P ¼ .001). A lower rate of PSMs was found in patients treated with simple enucleation rather than standard PN (1.6% vs. 7.4%, respectively; P < .0001). A greater incidence of PSMs was found in Fuhrman 3/4 tumors (11.3%; P < .0001). At multivariable analysis, age (odds ratio [OR], 1.04; P ¼ .01), upper pole tumor location (OR, 2.85; P ¼ .005), standard PN (OR, 3.45; P ¼ .004), and Fuhrman 3-4 nuclear grade (OR, 4.81; P ¼ .001) were found to be independent predictors of PSMs. Conclusion: In our multi-institutional report, young age, simple enucleation, middle or lower tumor location, and low-grade tumor were demonstrated to be independent predictors of negative SMs.

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Section: Riccardo Schiavina Et Alcontrasting

confidence: 55%

Section: Introductionmentioning

confidence: 99%

A Prospective, Multicenter Evaluation of Predictive Factors for Positive Surgical Margins After Nephron-Sparing Surgery for Renal Cell Carcinoma: The RECORd1 Italian Project

Schiavina

Serni

Mari

et al. 2015

Clinical Genitourinary Cancer

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“…Given that RS can accurately distinguish normal and cancerous renal tissue, it could be used to assess the margin status of tumour resection in real time during partial nephrectomy as it has already been demonstrated with reflectance spectroscopy [15]. It could represent an alternative to frozen section analysis that lacks specificity [17]. RS could also help the pathologist improve diagnostic accuracy.…”

Section: Discussionmentioning

confidence: 99%

Raman Spectroscopy: A Novel Experimental Approach to Evaluating Renal Tumours

et al. 2010

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“…18 Also, there is controversy with regard to considering surgical margins as a surrogate for oncologic outcomes. Some studies have demonstrated that PSM after PN increases the probability of local recurrence without influencing cancer-specific survival, 19 while others have shown that PSM increases the risk of local recurrence as well as metastasis. 15 The median WIT for simple tumors was 15 (IQR 9) minutes, which is within the safe range of <25 minutes described by Thompson and associates.…”

Section: Surgical Techniquementioning

confidence: 99%

Comparison of Perioperative Outcomes of Robot-Assisted Partial Nephrectomy and Open Partial Nephrectomy in Patients with a Solitary Kidney

Zargar

Bhayani

Allaf

et al. 2014

Journal of Endourology

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Results: 40 RAPN and 85 OPN cases were identified. For both tumor complexity groups, patients in each treatment modality were comparable. There were higher proportions of OPN cases in the complex group (61.2% vs 25%; P = 0.001). For both complexity tumor groups, there was no statistical difference between the treatment modalities in overall intraoperative/postoperative complications, transfusion rate, and positive surgical margin (PSM) rates. Patients in the RAPN group had a shorter length of hospital stay. For the entire cohort, there was no difference in estimated glomerular filtration rate preservation beyond 1 month (OPN 80.51%, RAPN 81.29%). Limitations include retrospective, nonrandomized nature of the series and small number of cases in the RAPN groups. Conclusions: In the solitary kidney, RAPN offers comparable perioperative and short-term functional outcomes for localized tumors with low R.E.N.A.L. score. For more complex tumors, our early experience suggests comparability, but these results were obtained in selected cases and future studies will need to validate these results.

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Positive Surgical Margin Appears to Have Negligible Impact on Survival of Renal Cell Carcinomas Treated by Nephron-Sparing Surgery

Cited by 239 publications

References 18 publications

A Prospective, Multicenter Evaluation of Predictive Factors for Positive Surgical Margins After Nephron-Sparing Surgery for Renal Cell Carcinoma: The RECORd1 Italian Project

A Prospective, Multicenter Evaluation of Predictive Factors for Positive Surgical Margins After Nephron-Sparing Surgery for Renal Cell Carcinoma: The RECORd1 Italian Project

Raman Spectroscopy: A Novel Experimental Approach to Evaluating Renal Tumours

Comparison of Perioperative Outcomes of Robot-Assisted Partial Nephrectomy and Open Partial Nephrectomy in Patients with a Solitary Kidney

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