Positive Surgical Margins Increase Risk of Recurrence after Partial Nephrectomy for High Risk Renal Tumors

Shah, Paras; Moreira, Daniel M.; Okhunov, Zhamshid; Patel, Vinay; Chopra, Sameer; Razmaria, Aria; Alom, Manaf; George, Arvin; Yaskiv, Oksana; Schwartz, Michael; Desai, Mihir; Vira, Manish; Richstone, Lee; Landman, Jaime; Shalhav, Arieh L.; Gill, Inderbir S.; Kavoussi, Louis R.

doi:10.1016/j.juro.2016.02.075

Cited by 136 publications

(93 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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). 8 In ablative procedures, frozen sections of core biopsies are sometimes used intraoperatively to confirm diagnosis at the outset of the procedure.…”

Section: Introductionmentioning

confidence: 99%

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

Vijayalakshmi

Shankar

Bain

et al. 2020

Intl Journal of Cancer

View full text Add to dashboard Cite

Clear cell renal cell carcinoma (ccRCC) is the most common and lethal subtype of kidney cancer. Intraoperative frozen section (IFS) analysis is used to confirm the diagnosis during partial nephrectomy. However, surgical margin evaluation using IFS analysis is time consuming and unreliable, leading to relatively low utilization. In our study, we demonstrated the use of desorption electrospray ionization mass spectrometry imaging (DESI-MSI) as a molecular diagnostic and prognostic tool for ccRCC. DESI-MSI was conducted on fresh-frozen 23 normal tumor paired nephrectomy specimens of ccRCC. An independent validation cohort of 17 normal tumor pairs was analyzed. DESI-MSI provides two-dimensional molecular images of tissues with mass spectra representing small metabolites, fatty acids and lipids. These tissues were subjected to histopathologic evaluation. A set of metabolites that distinguish ccRCC from normal kidney were identified by performing least absolute shrinkage and selection operator (Lasso) and log-ratio Lasso analysis. Lasso analysis with leave-one-patient-out crossvalidation selected 57 peaks from over 27,000 metabolic features across 37,608 pixels obtained using DESI-MSI of ccRCC and normal tissues. Baseline Lasso of metabolites predicted the class of each tissue to be normal or cancerous tissue with an accuracy of 94 and 76%, respectively. Combining the baseline Lasso with the ratio of glucose to arachidonic acid could potentially reduce scan time and improve accuracy to identify normal (82%) and ccRCC (88%) tissue. DESI-MSI allows rapid detection of metabolites associated with normal and ccRCC with high accuracy. As this technology advances, it could be used for rapid intraoperative assessment of surgical margin status.K.V.L. and V.S. contributed equally to this work Ryan M. Bain's current address is: Dow Chemical Co., Midland, MI 48674 Additional Supporting Information may be found in the online version of this article.

show abstract

Section: Introductionmentioning

confidence: 99%

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

Vijayalakshmi

Shankar

Bain

et al. 2020

Intl Journal of Cancer

View full text Add to dashboard Cite

show abstract

“…Additionally, a study of 641 consecutive RAPNs in the Washington University demonstrated that cerebrovascular disease was a predictor of perioperative complication [29]. The oncological safety is of the paramount importance in cancer surgery [30]. There was no positive surgical margin of our first 77 consecutive RAPN patients in different clamping techniques.…”

Section: Discussionmentioning

confidence: 98%

The Impact of Arterial Clamping Technique in Robot-Assisted Partial Nephrectomy on Renal Function and Surgical Outcomes: Six-Year Experience at Siriraj Hospital, Thailand

Taweemonkongsap¹,

Suk-Ouichai²,

Chotikawanich³

et al. 2018

Urol Int

View full text Add to dashboard Cite

Introduction: Robot-assisted partial nephrectomy (RAPN) with different arterial clamping techniques has increasingly been performed to avoid ischemic injury to nephron. However, postoperative renal function remains controversial. We determine the impact of each renal arterial clamping on surgical and renal outcomes after RAPN. Materials and Methods: Patients who underwent RAPN at Siriraj Hospital from 2010 to 2016 were retrospectively reviewed and stratified into 3 cohorts: main-clamp (MAC), selective-clamp, and off-clamp. Results: Main, selective, and off-clamping were performed in 27, 38, and 12, respectively. Median tumor size and Radius, Exophytic or endophytic, Nearness to collecting system or sinus, Anterior or posterior, and Location relative to polar lines (RENAL) score were 3 cm and 7, respectively. Longer operative time was observed in MAC (p = 0.002) although estimated blood loss, transfusion rate, and complication were comparable. Warm ischemia time was not different between cohorts. However, number of patients with prolonged ischemia time in MAC were greater (p ≤ 0.01). All margins were negative. Median postoperative and latest glomerular filtration rate reduction were 3.8 and 5.3 mL/min/1.73 m², respectively without significant difference between cohorts. On multivariable analysis, hypertension independently associated with reduced renal function preserved (p = 0.03). Median follow-up was 18 months. Conclusions: Our study is the first to report surgical and renal functional outcomes after RAPN in Southeast-Asian population. Based on our experience, clamping techniques does not impact on renal functions and complication rate was low even in small-volume center.

show abstract

“…Imperative reasons for PN certainly exist (eg, solitary kidney, significant CKD, etc), and our data support consideration of elective PN in patients age <65 years with amenable T1b and T2 tumors. Yet these benefits must be balanced with the increased oncologic potential of larger tumors and the elevated risk of perioperative complications inherent to more complex surgeries . Current clinical guidelines suggest that RN may be preferable in highly complex tumors when no preoperative CKD or proteinuria exists, the contralateral kidney appears normal, the predicted estimated glomerular filtration rate after RN is >45 mL/minute/1.73 m 2 , and PN would be challenging even in experienced hands .…”

Section: Discussionmentioning

confidence: 99%

Partial nephrectomy is not associated with an overall survival advantage over radical nephrectomy in elderly patients with stage Ib‐II renal masses: An analysis of the national cancer data base

Ristau

Handorf

Cahn

et al. 2018

Cancer

View full text Add to dashboard Cite

show abstract

Positive Surgical Margins Increase Risk of Recurrence after Partial Nephrectomy for High Risk Renal Tumors

Abstract: Positive surgical margins after partial nephrectomy increase the risk of disease recurrence, primarily in patients with adverse pathological features.

Cited by 136 publications

References 31 publications

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

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

The Impact of Arterial Clamping Technique in Robot-Assisted Partial Nephrectomy on Renal Function and Surgical Outcomes: Six-Year Experience at Siriraj Hospital, Thailand

Partial nephrectomy is not associated with an overall survival advantage over radical nephrectomy in elderly patients with stage Ib‐II renal masses: An analysis of the national cancer data base

Contact Info

Product

Resources

About