Surgical Margins in Nephron-Sparing Surgery for Renal Cell Carcinoma

Abstract

The oncologic impact of positive surgical margins after nephron-sparing surgery is controversial. Herein, we discuss current data surrounding surgical margins in the operative management of renal cell carcinoma. The prevalence, risk factors, outcomes, and subsequent management of positive surgical margins will be reviewed. Literature suggests that the prevalence of positive surgical margins following kidney surgery varies by practice setting, tumor characteristics, and operation type. For patients undergoing nephron-sparing surgery, it is not necessary to remove a margin of healthy tissue. Tumor enucleation may be appropriate and is associated with comparable outcomes. Reflexive intraoperative frozen section use does not provide beneficial information and many patients with positive margins can be monitored closely with serial imaging. The impact of positive surgical margins on recurrence and survival remains conflicting. Though every effort must be performed to obtain negative margins, a positive surgical margin appears to have a marginal impact on recurrence and survival.

Hospital volume and outcomes of robot‐assisted partial nephrectomy

“…Hospital volume categories were determined according to the following criteria: very low volume, 1-7 cases (n = 3 693); low volume, 8-14 cases (n = 3 719); medium volume, 15-23 cases (n = 3 833); high volume, 24-43 cases (n = 3 649); and very high volume, ≥44 cases (3 830). The median (interquartile range) hospital volume increased from 15 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) Baseline characteristics of the cohort are summarized in Table 1. The unadjusted outcome comparison across the strata of hospital volume is shown in Fig.…”

Percutaneous radiofrequency and microwave ablation in the treatment of renal tumors - 10 years of experience.

“…Nephron-sparing surgery has an advantage because of the possibility of histological verification and evaluation of surgical margins. If these margins are negative for a tumorous process, then the treatment is considered radical [ 14 ]. The disadvantages of surgical treatment include an operation wound in the lumbar region, which is often painful and requires general anesthesia and may lead to further complications such as seroma, urinoma, inflammation, or vascular impairment (pseudoaneurysm) with a high risk of serious bleeding [ 15 ].…”

Identification of diagnostic metabolic signatures in clear cell renal cell carcinoma using mass spectrometry imaging

“…1 In PN, the incidence of positive surgical margins (PSMs) in patients with small renal masses varies from 0.1 to 7% and for advanced RCC patients, from 18 to 32%. 2,3 Although the impact of PSM on long-term survival in RCC remains controversial, 4 large observational studies have shown that PSMs are significantly associated with higher rates of local recurrence and worse overall survival independent of other predictors. [5][6][7] Despite the importance of surgical margin assessment, only 69% of surgeons performing open and 58% performing laparoscopic PN report using intraoperative frozen sections (IFSs).…”