The Prognostic Impact of the Surgical Margin in Renal Cell Carcinoma Treated with Partial Nephrectomy: A Multi-Center Study

CANCERS(2024)

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Simple Summary Patients with small kidney cancers who undergo tumor resection, can experience incomplete tumor tissue removal. This is termed "positive surgical margin" (PSM) and is of interest in terms of the risk for cancer recurrence and survival outcomes. In this study, we investigated outcomes in 523 patients, of which 48 patients had PSM after tumor resection. We found positive margin rates to be lower in robot-assisted tumor resection compared to traditional methods (5.5% vs. 12.2%). Patients with a PSM had higher rates of recurrence during follow-up compared to patients with negative margins (23% vs. 9.3%), highlighting the impact of surgical approach in preventing PSM and thereby influencing the risk of cancer recurrence. However, the presence of PSM did not affect patient survival.Abstract Background: Partial nephrectomy (PN) is the preferred treatment for small, localized kidney tumors. Incomplete resection resulting in positive surgical margins (PSM) can occur after PN. The impact of PSM on the risk of recurrence and survival outcomes is not fully understood. We aimed to explore the relationship between PSM, the risk of recurrence and impact on survival after PN in a large multicenter cohort from Denmark. Methods: This was a retrospective cohort study including patients who underwent PN for renal cell carcinoma (RCC) at three departments in Denmark between 2010 and 2016. Data including pathological features, surgical techniques, and patient follow-up was retrieved from electronic medical health records and national databases. We used a combination of descriptive statistics, comparative analysis (comparisons were carried out by Mann-Whitney Test, independent Student's t-test, or Pearson's chi-Square Test), univariate and multivariate logistic regression analyses, and survival analysis methods. Results: A total of 523 patients were included, of which 48 (9.1%) had a PSM. Recurrence was observed in 55 patients (10.5%). Median follow-up time was 75 months. We found a lower incidence of PSM with robot-assisted PN (p = 0.01) compared to open or laparoscopic PN. PSM was associated with a higher risk of recurrence compared to negative margins in univariate analysis, but not multivariate analysis. However, the study was underpowered to describe this association with other risk factors. Overall survival did not differ between patients with PSM and negative margins. Conclusions: Our study presents further evidence on the negative impact of PSM on recurrence after PN for RCC, highlighting the importance of achieving NSM, thus potentially improving clinical outcomes. A surgical approach was found to be the only predictive factor influencing the risk of PSMs, with a reduced risk observed with robot-assisted laparoscopy.
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nephron-sparing surgery,positive surgical margins,renal cell carcinoma,robotic-assisted surgery,cancer recurrence
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