Variation in Surgical Margin Status by Surgical Approach among Patients Undergoing Partial Nephrectomy for Small Renal Masses

Tabayoyong, William; Abouassaly, Robert; Kiechle, Jonathan E.; Cherullo, Edward E.; Meropol, Neal J.; Shah, Nilay D.; Dong, Shan; Thompson, R. Houston; Smaldone, Marc C.; Zhu, Hui; Ialacci, Sarah; Kim, Simon P.

doi:10.1016/j.juro.2015.06.076

Cited by 61 publications

(47 citation statements)

References 28 publications

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“…Only two comparative studies showed significant differences in terms of PSM rate between different surgical approaches. Specifically, Tabayoyong et al reported lower PSMs rate in patients who underwent OPN compared with those receiving a minimally invasive approach [22]. Similarly, Zargar et al reported a lower PSMs rate in OPN compared with RAPN [11].…”

Section: Resultsmentioning

confidence: 99%

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%

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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“…Thirty‐four eligible studies included 60 808 patients who underwent PN, of whom 19 638 underwent RaPN with mean age 58.9 years and 41 170 underwent OPN with mean age 58.5 years. Table presents the baseline patient demographics of all enrolled studies.…”

Section: Resultsmentioning

confidence: 99%

Open versus robotic partial nephrectomy: Systematic review and meta‐analysis of contemporary studies

Tsai

Tseng²,

Sherer

et al. 2018

Robotics Computer Surgery

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Objectives To compare perioperative outcomes of robotic‐assisted partial nephrectomy (RaPN) with open partial nephrectomy (OPN). Methods Systematically search through PubMed, Embase, ClinicalKey, Cochrane Library, ProQuest, ScienceDirect, Web of Science, and http://ClinicalTrials.gov for eligible studies was performed to April 11, 2018. A meta‐analysis was conducted for studies comparing RaPN and OPN. Confounding variables were assessed by meta‐regression or subgroup analysis. Results This study included 34 studies with 60 808 patients. Meta‐analysis revealed less blood loss, less transfusion, longer operative time, less postoperative complications, lower readmission rate, shorter length of stay, and less estimated glomerular filtration rate (eGFR) decline in RaPN groups. The superiority of RaPN in blood loss was attenuated with highly complex renal masses. The superiority of RaPN in intraoperative complications was strengthened with renal hilar control. The advantage of RaPN in surgical margin was increased in patient with body mass index (BMI) < 28. Conclusions Compared with OPN, RaPN provided lower morbidities and better renal function preservation.

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“…The prevalence of PSM in nephron-sparing techniques has been reported to be in the range of 4.9–8.1% for the open and laparoscopic approaches. 22 PSM range has been reported to be 0–8.7% for the robotic approach. 10–16,22 In our series, we did not encounter any PSMs in the final pathology.…”

Section: Discussionmentioning

confidence: 99%

“…22 PSM range has been reported to be 0–8.7% for the robotic approach. 10–16,22 In our series, we did not encounter any PSMs in the final pathology. Several intra-operative techniques can aid in accomplishing the above-mentioned goal of achieving negative surgical margins.…”

Section: Discussionmentioning

confidence: 99%

Robot-Assisted Partial Nephrectomy for T1b Tumors: Strict Trifecta Outcomes

Tüfek

Mourmouris

Doğanca

et al. 2017

JSLS

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Background and Objectives:“Trifecta” in partial nephrectomy consists of negative surgical margins, minimal renal function decrease and absence of complications. In the present article, our single-center robot-assisted partial nephrectomy (RAPN) experience in T1b renal masses is reported in terms of strict Trifecta outcomes.Methods:This is a retrospective analysis of patients with a tumor diameter between 4 and 7 cm (stage T1b), who underwent RAPN by a single surgeon. Preoperative, intraoperative, and postoperative data were recorded and analyzed to evaluate short-term functional and oncologic outcomes. Patients with absence of grade ≥ 2 Clavien-Dindo complications, warm ischemia time (WIT) ≤25 minutes, ≤15% postoperative estimated glomerular filtration rate (eGFR) decrease and negative surgical margins were reported to achieve strict Trifecta outcomes. P < .05 was indicated statistically significant.Results:A total of 150 patients underwent RAPN, and 50 patients were identified with tumor size between 4 and 7 cm. Mean WIT was 20.8 ± 6.2 minutes and mean estimated blood loss (EBL) was 269 ± 191 mL. Surgical margins were negative in all patients. Eleven patients (22%) had a >15% eGFR decrease after surgery. Nine patients (18%) had WIT longer than 25 minutes. Four patients (8%) had grade ≥2 Clavien-Dindo complications. Twenty-nine (58%) patients had strict Trifecta outcomes. Mean follow-up was 44.2 ± 27.2 months. Tumor recurrence was not observed in any patient.Conclusions:Robot-assisted laparoscopic partial nephrectomy for T1b renal masses can be safely performed in experienced hands. Optimal strict Trifecta outcomes and recurrence rates can be achieved.

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Variation in Surgical Margin Status by Surgical Approach among Patients Undergoing Partial Nephrectomy for Small Renal Masses

Abstract: Laparoscopic and robotic partial nephrectomy is associated with higher positive surgical margin rates compared to open partial nephrectomy for clinical T1a renal cell carcinoma. The effect of margin status on long-term oncologic outcomes in this context remains to be determined.

Cited by 61 publications

References 28 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

Open versus robotic partial nephrectomy: Systematic review and meta‐analysis of contemporary studies

Robot-Assisted Partial Nephrectomy for T1b Tumors: Strict Trifecta Outcomes

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