Positive surgical margins after nephron-sparing surgery for renal cell carcinoma: incidence, clinical impact, and management.
Nephron-sparing surgery (NSS) for renal cell carcinoma (RCC) offers comparable oncologic results but a lower risk of chronic kidney disease when compared with radical nephrectomy; however it can result in positive surgical margins (PSMs) and consequently to a possible risk of oncologic failure. The aim of this review is to evaluate the incidence of PSMs after nephron-sparing surgery, to assess their clinical and oncologic impact, and to provide an overview of the possible therapeutic management. We performed a nonsystematic review of the literature in the MEDLINE database using the following keywords: partial nephrectomy, nephron-sparing surgery, and positive margin. We reviewed articles published only in English from January 2002 to May 2012. The overall incidence of PSMs after NSS ranges from 0% to 7%, with no significant differences in open, laparoscopic, and robot-assisted techniques. Smaller tumor size could result in a higher risk of PSMs. Even if there is not a clear agreement in the clinical evidence, local recurrence seems to be more likely in patients with PSMs, especially in those with high-grade tumors. Development of metastases and cancer-specific survival, as seen in midterm follow-up studies, seems to be comparable to those in patients with negative surgical margins. Considering the globally low risk of local recurrence, development of metastasis, or cancer-specific mortality, careful surveillance could be the best management option for most patients with PSMs after NSS.
Department of Urology, Azienda Ospedaliero-Universitaria Policlinico S. Orsola-Malpighi, Bologna, Italy. mark.borghesi@gmail.com
Marco
M
Borghesi
Eugenio
E
Brunocilla
Riccardo
R
Schiavina
Giuseppe
G
Martorana
D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000601:surgery*; D019468:Disease Management; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000401:mortality / Q000601:surgery*; D010535:Laparoscopy; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009392:Nephrectomy / Q000379:methods*; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome