Predictors of Positive Surgical Margins after Robot-Assisted Partial Nephrectomy for Localized Renal Tumors: Insights from a Large Multicenter International Prospective Observational Project (The Surface-Intermediate-Base Margin Score Consortium)

Abstract

Background: To explore predictors of positive surgical margins (PSM) after robotic partial nephrectomy (PN) in a large multicenter international observational project, harnessing the Surface-Intermediate-Base (SIB) margin score to report the resection technique after PN in a standardized way. Methods: Data from consecutive patients with cT1-2N0M0 renal masses treated with PN from September 2014 to March 2015 at 16 tertiary referral centers and included in the SIB margin score International Consortium were prospectively collected. For the present study, only patients treated with robotic PN were included. Uni- and multivariable analysis were fitted to explore clinical and surgical predictors of PSMs after PN. Results: Overall, 289 patients were enrolled. Median (IQR) preoperative tumor size was 3.0 (2.3–4.2) cm and median (IQR) PADUA score was 8 (7–9). SIB scores of 0–2 (enucleation), 3–4 (enucleoresection) and 5 (resection) were reported in 53.3%, 27.3% and 19.4% of cases, respectively. A PSM was recorded in 18 (6.2%) patients. PSM rate was 4.5%, 11.4% and 3.6% in case of enucleation, enucleoresection and resection, respectively. Patients with PSMs had tumors with a higher rate of contact with the urinary collecting system (55.6% vs. 27.3%; p < 0.001) and a longer median warm ischemia time (22 vs. 16 min; p = 0.02) compared with patients with negative surgical margins, while no differences emerged between the two groups in terms of other tumor features (i.e., pathological diameter, PADUA score). In multivariable analysis, only enucleoresection (SIB score 3–4) versus enucleation (SIB score 0–2) was found to be an independent predictor of PSM at final pathology (HR: 2.68; 95% CI: 1.25–7.63; p = 0.04), while resection (SIB score 5) was not. Conclusions: In our experience, enucleoresection led to a higher risk of PSMs as compared to enucleation. Further studies are needed to assess the differential impacts of resection technique and surgeon’s experience on margin status after robotic PN.

Three-dimensional virtual model for robot-assisted partial nephrectomy: a propensity-score matching analysis with a contemporary control group

“…For the study purpose Chronic kidney disease (CKD) stage was assessed according to the Kidney Disease Improvement Global Outcomes-KDIGO criteria [15]. Resection technique was visually classified by the surgeon as enucleation (SIB score 0-2), enucleoresection (SIB score [3][4] or resection (SIB score 5) according to the SIB score, as previously reported [16].…”

3D virtual model for robot-assisted partial nephrectomy in highly-complex cases (PADUA ⩾ 10)

“…For the study purpose Chronic kidney disease (CKD) stage was assessed according to the Kidney Disease Improvement Global Outcomes-KDIGO criteria. 11 Resection technique was visually classified by the surgeon as enucleation (SIB score 0-2), enucleoresection (SIB score [3][4] or resection (SIB score 5) according to the SIB score, as previously reported. [12][13][14] Outcomes Our primary endpoint was to evaluate whereas RAPNs with 3DVM were superior in terms of functional outcomes defined as 12-month creatinine serum level and 12-month eGFR in the overall cohort and in subgroup analysis.…”

Predicting positive surgical margins in patients treated with robot-assisted partial nephrectomy: results from a prospectively maintained dataset of a single tertiary referral center

“…Partial nephrectomy (PN) has been widely accepted as the preferred treatment for patients with clinical T1 renal cell carcinoma (RCC) [1] . This method not only offers the advantage of preserving renal function but also has oncologic outcomes similar to radical nephrectomy [2,3] . However, one challenge in PN is the potential for positive surgical margins (PSMs).…”