Positive margins after nephron-sparing surgery for renal cell carcinoma: long-term follow-up of patients on active surveillance.
OBJECTIVE
To analyse our long-term oncological outcomes with active surveillance in patients with positive surgical margins (PSMs) after nephron-sparing surgery (NSS) for renal cell carcinoma (RCC), as this situation is a difficult therapeutic dilemma.


METHODS
We performed open NSS for renal masses with frozen-section analysis of any suspicious zone of the surgical bed, followed by extensive argon-beam coagulation. In patients where the final histopathological examination of the renal mass revealed PSMs, follow-up consisted of computed tomography (CT) every 6 months in the first 2 years and then annually up to 5 years, and thereafter we alternated ultrasonography with CT.


RESULTS
From 1995 to 2003 we had 11 cases of microscopic definitive PSMs after NSS for RCC. Two patients required nephrectomy (one for postoperative bleeding and another as an elective procedure), so nine were followed. These patients were either operated under elective (seven) or imperative (two) conditions. The histological subtype was clear cell carcinoma in three, papillary in two, chromophobe in two and hybrid oncocytic RCC in two, with a Furhman grade of 2 in six and 3 in three. The mean size was 31.4 mm, and the stage was pT1a in six, pT1b in one and pT3a in two. After a median follow-up of 80.5 months, there was no local recurrence or distant progression.


CONCLUSIONS
In our experience, microscopic PSMs in NSS specimens can be managed conservatively with active surveillance, achieving excellent results and avoiding extensive reoperation without compromising long-term oncological outcomes.
Lopez-Costea
Miguel A
MA
Hospital Universitari de Bellvitge, University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain.
Fumadó
Lluís
L
Lorente
David
D
Riera
Luis
L
Miranda
Eladio Franco
EF
D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons; D011379:Prognosis; D016896:Treatment Outcome; D047368:Tumor Burden