title: Positive surgical margins after nephron-sparing surgery.
abstract: BACKGROUND
  Little is known on the natural history of positive surgical margins (PSMs) in partial nephrectomy (PN). Accumulating data suggest that secondary nephrectomy might not be necessary in all patients with PSMs after PN.
  
  
  OBJECTIVE
  Provide an overview on incidence and risk factors for PSMs after partial nephrectomy and on the rate of local and distant disease recurrence related to PSMs. We also provide recommendations on how to avoid and how to treat PSMs after PN.
  
  
  METHODS
  A nonsystematic literature research was based on Medline, Scopus, and Web of Science queries on these keywords: nephron-sparing surgery, partial nephrectomy/ies, and margin. Only human studies (original research) published in English were included.
  
  
  RESULTS
  PSMs are present in 0-7% of patients after open PN, in 0.7-4% after laparoscopic PN, and in 3.9-5.7% after robot-assisted PN. The thickness of healthy parenchyma surrounding the tumour is irrelevant as long as complete tumour removal is achieved. The coincidence of a highly malignant tumour and PSM increases the risk of local recurrence. Intermediate follow-up data indicate that the vast majority of patients with PSMs will not experience local or distant tumour recurrence. Frozen-section analysis for evaluation of resection margins during PN is of minor clinical significance, as the surgeon's gross assessment of macroscopically negative margins provides reliable results.
  
  
  CONCLUSIONS
  PSMs in PN are rare. As indicated by intermediate follow-up data, the majority of patients with PSMs after PN remain without disease recurrence, and a surveillance strategy seems preferable to surgical reintervention.
authors.affiliation: Department of Urology and Andrology, Donauspital, Vienna, Austria. martin.marszalek@wienkav.at
authors.forename: Martin
authors.initials: M
authors.lastname: Marszalek
authors.forename: Marco
authors.initials: M
authors.lastname: Carini
authors.forename: Piotr
authors.initials: P
authors.lastname: Chlosta
authors.forename: Klaus
authors.initials: K
authors.lastname: Jeschke
authors.forename: Ziya
authors.initials: Z
authors.lastname: Kirkali
authors.forename: Ruth
authors.initials: R
authors.lastname: Knüchel
authors.forename: Stephan
authors.initials: S
authors.lastname: Madersbacher
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Patard
authors.forename: Hendrik
authors.initials: H
authors.lastname: Van Poppel
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D059351:Organ Sparing Treatments / Q000009:adverse effects / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome