Oncologic outcomes of patients with positive surgical margin after partial nephrectomy: a 25-year single institution experience

Petros, Firas; Metcalfe, Michael; Yu, Kai; Keskin, Sarp Korcan; Fellman, Bryan; Chang, Courtney M.; Gu, Cindy; Tamboli, Pheroze; Matin, Surena F.; Karam, Jose A.; Wood, Christopher G.

doi:10.1007/s00345-018-2241-7

Cited by 38 publications

(26 citation statements)

References 26 publications

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“…Specifically, multivariable analyses demonstrated that PSMs are a strong predictor of local recurrence especially in combination with high nuclear grade of the tumor [29,39]. Recently, Petros et al reported a significant impact of PSMs on local recurrence-free survival and metastasis-free survival, failing to demonstrate a significant impact on overall survival [41]. Conversely, Bansal et al failed to demonstrate a significant role of PSMs on disease progression at multivariable analysis [38].…”

Section: Resultsmentioning

confidence: 99%

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Positive Surgical Margins After Partial Nephrectomy: A Systematic Review and Meta-Analysis of Comparative Studies

Ficarra

Crestani

Inferrera

et al. 2018

KCA

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Objective: We performed an update of previous reviews of the literature to provide an overview on incidence, predictive factors, management and prognosis of positive surgical margins (PSMs) after partial nephrectomy (PN) including recent surgical series and studies comparing different approaches and techniques. Material and methods: A literature search was performed from January 2013 to January 2018 using the Medline database. The search strategy included a free-text protocol using the term "nephron-sparing surgery" OR "partial nephrectomy" AND "positive surgical margins" across the title and abstract fields of the records. From each selected study, we extracted the following data: number of analyzed patients, study design, approach and surgical technique used, PSMs rate, pathological features, type of PSMs treatment, mean (median) follow-up duration and final patient status. Meta-analysis was conducted using Review Manager software v. 5.2 (Cochrane Collaboration, Oxford, UK). Results: We selected a total of 36 (48%) studies. All studies were retrospective and the best statistical method used for comparison was the matched-pair analysis (level 4). Overall, 45,786 patients treated with PN were included in the selected studies. PSMs were reported in a total of 3,093 (6.7%) patients. The mean estimated PSMs rate was 7%, 5% and 4.3% in patients who underwent robot-assisted PN (RAPN), laparoscopic PN (LPN) and open PN (OPN), respectively. Comparative studies showed a significant advantage in favor of OPN compared with minimally invasive approach, while RAPN showed more favourable PSMs risk compared with LPN (odds ratio 3.02, 95% confidence intervals 2.05-4.45). No differences were detected stratifying data according to other surgical or tumor-related factors. Tumor size, nuclear grading and pT3a stage represent the most important predictors of PSMs. In 6,809 patients, follow-up data were available. Only 101 (1.4%) local recurrences and 88 (1.3%) distant recurrences were observed both in PSMs and negative surgical margins subgroups. PSMs were associated with a significant increased risk of local recurrence with a significant impact on local recurrence-free survival and metastasis-free survival. However, a significant impact on cancer-specific and overall survival could not be demonstrated.

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Section: Resultsmentioning

confidence: 99%

“…No study in the previous reviews reported a negative impact of PSMs on cancer-specific or overall survival [1,2], Recently, Petros et al reported a significant impact of PSMs status on local recurrence-free survival and metastasis-free survival. Conversely, no effects on overall survival were reported [41].…”

Section: Discussionmentioning

confidence: 98%

Positive Surgical Margins After Partial Nephrectomy: A Systematic Review and Meta-Analysis of Comparative Studies

Ficarra

Crestani

Inferrera

et al. 2018

KCA

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“…With multiple oncometabolites implicated in numerous RCC subtypes including in ccRCC 99,101 and partial nephrectomies the gold-standard treatment for localised RCC 241 , utilising these methods may help optimise surgical margins in patients with oncometabolite-associated RCC undergoing partial nephrectomies. This may prove to be of great benefit as positive surgical margins have been demonstrated to correlate with tumour recurrence 242 . Furthermore, given the highly aggressive phenotypes of FHand SDH-deficient RCCs in which a significant proportion present with bilateral disease, utilising intraoperative mass spectrometry concurrently may assist in meticulous tumour resections to help preserve renal function in these patients.…”

Section: Biomarkers Of Diseasementioning

confidence: 99%

Oncometabolites in renal cancer

2019

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The study of cancer metabolism has evolved vastly beyond the remit of tumour proliferation and survival, with an unveiling of the ostensible role of 'oncometabolites' in tumorigenesis. Simply defined, oncometabolites are conventional metabolites that when aberrantly accumulated have prooncogenic functions. Their discovery has led us to revisit the original, dispelled Warburg hypothesis, first postulated in the 1950s, of aberrant metabolism as an aetiological determinant of cancer. As such, the identification of oncometabolites alongside their attractive utilisation in diagnostics and prognostics, as novel therapeutic targets and as biomarkers of disease, has been intensely sought after in oncology. To date, fumarate, succinate and 2-hydroxyglutarate have been characterised as bona fide oncometabolites. Renal cell carcinoma (RCC) is an established example of a cancer type with extensive metabolic reprogramming during tumour initiation and progression. With oncometabolites postulated to be rooted in the oncological origins and drivers of tumorigenesis, in combination with all three of these oncometabolites remarkably implicated in RCC, this timely review synthesises the literature to date on oncometabolites in RCC, their oncogenic mechanisms and the clinical impact oncometabolites may have in the management of RCC.

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“…in their large group long-term follow-up. [25] We had low number of PSM making it difficult to draw statistical conclusion. This study represents one large single center and surgeon experience with RPN, with acceptable length of follow-up.…”

Section: Discussionmentioning

confidence: 99%

The incidence and pattern of renal cell carcinoma recurrence after robotic partial nephrectomy

2019

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Background:Robotic partial nephrectomy (RPN) is a rapidly growing treatment for small renal mass (SRM). In fact, RPN has shown good functional and oncologic outcome. In this manuscript, we are reporting on the incidence and pattern of recurrence of renal cell carcinoma (RCC) treated with RPN.Patients and Methods:We reviewed prospectively collected data of patients who underwent RPN between September 2009 and March 2018. We selected patients with final pathologic diagnosis of RCC after the resection of their SRM. We described the incidence and pattern of recurrence in the patients who had it.Results:A total of 335 patients with SRM underwent RPN. We found 269 patients to have RCC on the final pathologic evaluation of the SRM. Eight cases of recurrence were found with a recurrence rate of 2.9% after the mean follow-up period of 31 months (range 18–72). The pattern of recurrence presented as follows: two patients (0.7%) had trocar site recurrence (TSR), one patient (0.37%) had locoregional recurrence, and three patients (1.1%) had recurrence of the disease at the resection bed. Two patients (0.7%) developed second primary tumor in the other kidney. No cancer-related mortality occurred during the follow-up period.Conclusion:TSR, locoregional recurrence, tumor bed recurrence, and contralateral tumor development are observed patterns of RCC recurrence after RPN. Recurrence was seen in up to 72 months. RPN provides great cancer control and high cure rate when utilized to treat RCC presenting as SRM.

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Oncologic outcomes of patients with positive surgical margin after partial nephrectomy: a 25-year single institution experience

Cited by 38 publications

References 26 publications

Positive Surgical Margins After Partial Nephrectomy: A Systematic Review and Meta-Analysis of Comparative Studies

Positive Surgical Margins After Partial Nephrectomy: A Systematic Review and Meta-Analysis of Comparative Studies

Oncometabolites in renal cancer

The incidence and pattern of renal cell carcinoma recurrence after robotic partial nephrectomy

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