Positive Surgical Parenchymal Margin After Laparoscopic Partial Nephrectomy for Renal Cell Carcinoma: Oncological Outcomes

Permpongkosol, Sompol; Colombo, José R.; Gill, Inderbir S.; Kavoussi, Louis R.

doi:10.1016/j.juro.2006.08.008

Cited by 129 publications

(73 citation statements)

References 14 publications

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“…The rate of PSM in various studies ranges from 0-18% and may be influenced by tumour size, tumour stage, fat invasion, imperative indication, solitary kidney, and surgical technique. [10][11][12]16,[20][21][22][23][24][25][26] Few studies have reported on the factors predicting PSM. Yossepowitch et al found association between decreasing tumour size and PSM.…”

Section: Discussionmentioning

confidence: 99%

Positive surgical margins during partial nephrectomy for renal cell carcinoma: Results from Canadian Kidney Cancer information system (CKCis) collaborative

Bansal¹,

Tanguay²,

Finelli³

et al. 2017

CUAJ

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Introduction: We sought to determine the incidence, risk factors, and prognosis for patients with positive surgical margin (PSM) during partial nephrectomy (PN) for renal cell carcinoma (RCC). Methods: From the Canadian Kidney Cancer information system (CKCis) database, a historical cohort of PN patients with PSM were identified and compared to negative surgical margin (NSM). Risk factors for PSM were examined through multivariable logistic regression. Kaplan-Meier curves were used to compare progression-free survival. Results: Of 1103 patients, 972 (88.1%), 71 (6.4%), and 60 (5.4%) had NSM, PSM, and unknown status, respectively. Median patient age and tumour size were 61 years and 3.0 cm for both groups. From multivariable analysis, pathological stage ≥T3 (odds ratio [OR] 2.51; 95% confidence interval [CI] 1.13-5.60) and Fuhrman grade 4 (OR 5.35; 95% CI 1.11-25.72) were associated with PSM, whereas age, operative technique, and tumour size were not. Forty-nine (5.0%) patients from the NSM cohort and seven (9.9%) from the PSM cohort had a local/systemic progression of disease (adjusted hazard ratio [HR] 1.4; 95% CI 0.6-3.6). There were three (0.3%) cancer-related deaths in the NSM group and none in the PSM group. After median followup of 19 (interquartile range [IQR] 5-42) and 15 (IQR 7-30) months, 855 (91.4%) and 61 (89.7%) patients were alive in the NSM and PSM groups, respectively. Conclusions: PSM occurred in 6.4% of PNs performed for RCC in this pan-Canadian cohort. Higher stage and grade are associated with a higher risk of positive margin. The small association between a PSM and progression suggests that complete nephrectomy is not necessary in patients with a PSM. The main study limitations are lack of nephrometry score and possible reporting bias.

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Section: Discussionmentioning

confidence: 99%

Positive surgical margins during partial nephrectomy for renal cell carcinoma: Results from Canadian Kidney Cancer information system (CKCis) collaborative

Bansal¹,

Tanguay²,

Finelli³

et al. 2017

CUAJ

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“…49 Gupta et al similarly reported no local or metastatic recurrences following RPN at a median follow-up of 22 months. 78 Despite these early promising data for RPN, some studies have also shown a higher, albeit statistically insignificant, occurrence of positive surgical margins 79 Early studies had demonstrated an insignificant oncologic effect of PSM with respect to local or metastatic recurrence, 80,81 but emerging data conflict with these earlier findings. 82 Pending further studies on the oncologic significance of PSM during PN, meticulous and complete surgical resection with close follow-up of patients with known PSM is recommended.…”

Section: Oncologic Outcomesmentioning

confidence: 99%

Laparoscopic partial nephrectomy: state of the art review

Faiena¹,

Han²,

Olweny³

2014

OAS

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Introduction:The surgical management of small renal masses (,4 cm) has greatly evolved over the last few decades, with the paradigm shifting from radical to partial nephrectomy. Laparoscopic partial nephrectomy (LPN) is increasingly utilized, and has achieved similar outcomes to open partial nephrectomy with decreased patient morbidity in experienced hands. The aim of this review was to examine the current status and future direction of LPN. Materials and methods:We performed a nonsystematic review of the literature using a free-text protocol in the PubMed database, using the terms "laparoscopic partial nephrectomy", "robotassisted partial nephrectomy", "robotic partial nephrectomy", and "laparoscopic partial nephrectomy oncologic and functional outcomes". Only English language articles were selected. Evidence synthesis: Our search results yielded 1,136. Three authors reviewed the results, and articles with information on patient and tumor selection, surgical techniques, and oncologic and functional outcomes were included. With regard to outcomes, only series with the largest cohorts and longest follow-up were selected. Conclusion: LPN has evolved rapidly over the past 2 decades, and advances in technique as well as innovations in surgical technologies have facilitated its increased adoption in urologic practice. However, limitations remain, such as inadequacy of techniques to achieve cold ischemia laparoscopically, high technical demands of intracorporeal suturing, and limited ability to assess surgical anatomy beyond the field of view. These comprise goals of research aimed at improving future surgical precision and outcomes, while further decreasing the invasiveness of LPN.

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“…59 More importantly, margin positivity has not been consistently demonstrated to impact outcomes of metastatic progression or mortality. [60][61][62] Five-year local recurrence rates for PN are reported at 1-10%. [63][64][65] Rates of progression to distant metastasis are nearly equivalent between RN (3.7%) and PN (2.7%).…”

Section: Equivalent Oncologic Outcomesmentioning

confidence: 99%

1308 Partial Nephrectomy for the Treatment of Renal Cell Carcinoma and the Risk of End Stage Renal Disease

Yap¹,

Alibhai²,

Tomlinson³

et al. 2013

Journal of Urology

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The surgical management of renal masses involves either radical nephrectomy (RN) or partial nephrectomy (PN). PN has been associated with better long-term renal function, and has also been linked to improved cardiac morbidity and overall survival. However, the relationship between treatment choice and definitive outcomes of chronic kidney disease (CKD) are lacking. Our aim was to examine whether PN is associated with a lower risk of end-stage renal disease (ESRD) requiring renal replacement therapy.We performed a population-based, retrospective cohort study with data from linked administrative databases in the province of Ontario, Canada. We included individuals with pathologically confirmed renal cell carcinoma (RCC) diagnosed between 1995 and 2010. Cox proportional hazards (PH) models, propensity score models, and competing risks models were used to assess the impact of treatment choice. PN compared to RN reduces the risk of ESRD requiring renal replacement therapy in a modern cohort of patients (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). PN is associated with a lower risk of new-onset CKD, lower risk of cardiac morbidity, and improved overall survival. We provide further evidence for the benefit of PN compared to RN, particularly related to definitive outcomes of renal failure.iii ACKNOWLEDGEMENTS

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Positive Surgical Parenchymal Margin After Laparoscopic Partial Nephrectomy for Renal Cell Carcinoma: Oncological Outcomes

Cited by 129 publications

References 14 publications

Positive surgical margins during partial nephrectomy for renal cell carcinoma: Results from Canadian Kidney Cancer information system (CKCis) collaborative

Positive surgical margins during partial nephrectomy for renal cell carcinoma: Results from Canadian Kidney Cancer information system (CKCis) collaborative

Laparoscopic partial nephrectomy: state of the art review

1308 Partial Nephrectomy for the Treatment of Renal Cell Carcinoma and the Risk of End Stage Renal Disease

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