title: Self-assessment of surgical technique leads to reduction of positive surgical margins in partial nephrectomy.
abstract: The background of the study was to examine potential causes for a positive surgical margin (PSM) and develop strategies to improve surgical outcomes. A retrospective review of consecutive partial nephrectomy cases for renal cell carcinoma was performed. We divided the patients into 2 groups. The first group consisted of the first 67 renal tumors in 65 patients that underwent our early surgical technique. The second group consisted of the next 45 renal tumors in 39 patients that underwent the revised surgical technique which included wider resections and robotically controlled ultrasound. Our primary outcome was margin status and secondary outcome was disease recurrence. Univariate and multivariate analyses were performed to determine factors that resulted in a PSM. Positive margins were detected in 19 out of 67 (28 %) renal tumors in the early technique group compared to 1 out of 45 (2 %) positive margins in the revised technique group (p < 0.001). On multivariate analysis, only technique modification (OR 0.04, p = 0.003) and larger tumor size (OR 0.41, p = 0.01) were significant predictors of a lower rate of PSM. Smaller tumors were more common in robotic assisted partial nephrectomies which had a higher rate of PSM on univariate analysis (OR 3.51, p = 0.04). Only one patient with a PSM experienced a systemic disease recurrence. In our experience, self-assessment and technique modification resulted in a dramatic PSM improvement. Smaller tumors were associated with PSM. It is important for all surgeons to periodically look at their own surgical outcomes and modify their surgical technique accordingly.
authors.affiliation: Division of Urology, Albany Medical College, 43, New Scotland Ave, Albany, NY, 12208, USA. sorokii@mail.amc.edu.
authors.forename: Igor
authors.initials: I
authors.lastname: Sorokin
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275, York Avenue, New York, NY, 10065, USA. feuerstm@mskcc.org.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Feuerstein
authors.affiliation: Center for Neuropharmacology and Neuroscience, Albany Medical College, 43, New Scotland Ave, Albany, NY, 12208, USA. feustep@mail.amc.edu.
authors.forename: Paul
authors.initials: P
authors.lastname: Feustel
authors.affiliation: Division of Urology, Albany Medical College, 43, New Scotland Ave, Albany, NY, 12208, USA. rkaufman@communitycare.com.|Urological Institute of Northeastern New York, 23, Hackett Blvd, Albany, NY, 12208, USA. rkaufman@communitycare.com.
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Kaufman
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007668:Kidney / Q000601:surgery; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data*; D012647:Self-Assessment
keywords: Partial nephrectomy; Positive margins; Renal cell carcinoma; Robotic assisted partial nephrectomy