Positive Surgical Margins After Robot-Assisted Partial Nephrectomy Predict Long-Term Oncologic Outcomes for Clinically Localized Renal Masses

Wahba, Brandon Malik; Chow, Alexander K.; Du, Kefu; Sands, Kenneth G.; Paradis, Alethea; Vetter, Joel; Venkatesh, Ramakrishna; Kim, Eric; Bhayani, Sam B.; Figenshau, R. Sherburne

doi:10.1089/end.2020.0707

Cited by 5 publications

(3 citation statements)

References 25 publications

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“…The characteristics and quality of the included studies are summarized in Table 1 . There were 9 studies ( 6 , 16 , 24 , 27 , 31 – 34 , 44 ) explaining the specific quantitative differences between the two groups in different tumor stages. After statistical analysis, it was found that there were significant differences in patients with different stages between the two groups (p < 0.001) ( Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…Twelve studies including 10155 patients reported data on all-cause death in two groups ( 4 , 7 , 8 , 16 – 18 , 24 , 25 , 31 , 32 , 39 , 44 ), from which a significantly higher rate of all-cause death in the PSM group could be found than that in the NSM group (OR 1.51, 95% CI 1.19-1.93; p = 0.0008; Figure 4 ). However, subgroup analyses showed insignificant results between the two groups for those less than 3 years (OR 2.08, 95% CI 0.62-7.01; p = 0.24) and those more than 6 years (OR 1.26, 95% CI 0.73-2.17; p = 0.40) ( Figure 4 ).…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2022

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BackgroundSo far, whether positive surgical margin(PSM) has adverse effects on the prognosis of patients is still controversial, so we designed this study to systematically evaluate the effect of PSM on the prognosis of patients with renal cell carcinoma (RCC) after partial nephrectomy (PN).MethodsOn the basis of three electronic databases (PubMed, Embase and the Cochrane Library) up to May 2022, all case–control studies (CCSs) comparing the effects of PSM and negative surgical margin (NSM) after PN on the oncological results of RCC patients were included. Two evaluators independently conducted a systematic literature search and extracted the data we needed. The methodological quality of all studies was evaluated by the modified Newcastle–Ottawa scale. The odds ratio (OR) was used to describe the results for dichotomous variables, and the meta-analysis was conducted using Cochrane Review Manager 5.2 and Stata 14.2.ResultsA total of 39 studies involving 21461 patients were included in our meta-analysis. The pooled results showed that the rates of tumor recurrence (OR 3.93, 95% CI 2.95-5.24; p < 0.00001) and metastasis (OR 4.63, 95% CI 3.11-6.88; p < 0.00001) in the PSM group were significantly higher than those in the NSM group. However, there were no significant differences in the rates of all-cause death (OR 1.35, 95% CI 0.92-1.99; p = 0.13) or cancer-specific death (OR 0.99, 95% CI 0.51-1.94; p = 0.99) between the two groups. In addition, subgroup analyses were carried out according to different average follow-ups, which revealed similar results.ConclusionInsignificant differences in survival between the PSM and NSM groups were observed, although significant differences in recurrence and metastasis in the PSM group were reported. Our study supported that close monitoring might be another effective choice for patients with PSM after PN. Considering the possible limitations, we recommended cautious interpretation of our results.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

et al. 2022

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“…Malik Wahba et al . found that PSM substantially increases LR (3/12 patients vs. 8/362 patients) in patients with PSM after robot-assisted PN, however, overall survival was not affected ( p = 0.13) in their study with 77 months of follow-up [ 22 ]. A systematic review by Minervini et al, assessing the effect of surgical technique (simple enucleation versus standard partial nephrectomy) on surgical margins, whereas this systematic review focused on the effect of PSM as a risk factor for LR, irrespective of the technique used.…”

Section: Discussionmentioning

confidence: 99%

Surgical margins after partial nephrectomy as prognostic factor for the risk of local recurrence in pT1 RCC: a systematic review and narrative synthesis

et al. 2022

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Purpose To systematically review the published literature on surgical margins as a risk factor for local recurrence (LR) in patients undergoing partial nephrectomy (PN) for pT1 renal cell carcinomas (RCC). Evidence acquisition A systematic literature search of relevant databases (MEDLINE, Embase and the Cochrane Library) was performed according to the PRISMA criteria up to February 2022. The hypothesis was developed using the PPO method (Patients = patients with pT1 RCC undergoing PN, Prognostic factor = positive surgical margins (PSM) detected on final pathology versus negative surgical margins (NSM) and Outcome = LR diagnosed on follow-up imaging). The primary outcome was the rate of PSM and LR. The risk of bias was assessed by the QUIPS tool. Evidence synthesis After assessing 1525 abstracts and 409 full-text articles, eight studies met the inclusion criteria. The percentage of PSM ranged between 0 and 34.3%. In these patients with PSM, LR varied between 0 and 9.1%, whereas only 0–1.5% of LR were found in the NSM-group. The calculated odds ratio (95% confident intervals) varied between 0.04 [0.00–0.79] and 0.27 [0.01–4.76] and was statistically significant in two studies (0.14 [0.02–0.80] and 0.04 [0.00–0.79]). The quality analysis of the included studies resulted in an overall intermediate to high risk of bias and the level of evidence was overall very low. A meta-analysis was considered unsuitable due to the high heterogeneity between the included studies. Conclusion PSM after PN in patients with pT1 RCC is associated with a higher risk of LR. However, the evidence has significant limitations and caution should be taken with the interpretation of this data.

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Relevance of Positive Surgical Margins in Localized Renal Cell Carcinoma After Surgical Resection: Predictive Factors and Survival Implications

Egen,

Quan,

Gottstein

et al. 2024

Clinical Genitourinary Cancer

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Positive Surgical Margins After Robot-Assisted Partial Nephrectomy Predict Long-Term Oncologic Outcomes for Clinically Localized Renal Masses

Cited by 5 publications

References 25 publications

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

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

Surgical margins after partial nephrectomy as prognostic factor for the risk of local recurrence in pT1 RCC: a systematic review and narrative synthesis

Relevance of Positive Surgical Margins in Localized Renal Cell Carcinoma After Surgical Resection: Predictive Factors and Survival Implications

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