Impact of Positive Surgical Margins After Partial Nephrectomy

• Autor(a) principal: Carvalho, João André Mendes
• Data de Publicação: 2020
• Outros Autores: Nunes, Pedro, Silva, Edgar Tavares da, Parada, Belmiro, Jarimba, Roberto, Moreira, Pedro, Retroz, Edson, Caetano, Rui, Sousa, Vítor, Cipriano, Augusta, Figueiredo, Arnaldo
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10316/106075; https://doi.org/10.1016/j.euros.2020.08.006
• topic: Laparoscopy; Nephrectomy; Positive surgical margins

Background: The impact of positive surgical margins (PSMs) after partial nephrectomy (PN) is controversial. Objective: To evaluate the risk factors for a PSM and its impact on overall survival. Design, setting, and participants: This is a retrospective study of 388 patients were submitted to PN between November 2005 and December 2016 in a single centre. Two groups were created: PSM and negative surgical margin (NSM) after PN. A p value of <0.05 was considered significant. Outcome measurements and statistical analysis: Relationships with outcome were assessed using univariable and multivariable tests and log-rank analysis. Results and limitations: The PSM rate was 3.8% (N = 16). The mean age at the time of surgery (PSM group: 64.1 11.3 vs NSM group: 61.8 12.8 yr, p = 0.5) and the mean radiological tumour size (4.0 1.5 vs 3.4 1.8 cm, p = 0.2) were similar. Lesion location (p = 0.3), surgical approach (p = 0.4), warm ischaemia time (p = 0.9), and surgery time (p = 0.06) had no association with PSM. However, higher surgeon experience was associated with a lower PSM incidence (2.6% if 30 PNs vs 9.6% if <30 PNs; p = 0.02). Higher operative blood loss (p = 0.02), higher-risk tumours (p = 0.03), and larger pathological size (p = 0.05) were associated with an increase in PSM. In the PSM group, recurrence rate (18.7% vs 4.2%, p = 0.007) and secondary total nephrectomy rate (25% vs 4.4%, p < 0.001) were higher. However, overall survival was similar. Multivariate analysis revealed that high-risk tumour (p = 0.05) and low experience (p = 0.03) could predict a PSM. Limitations include retrospective design and reduced follow-up time. Conclusions: PSMs were mainly associated with high-risk pathological tumour (p = 0.05) and low-volume surgeon experience. Recurrence rate and need for total nephrectomy were higher in that group, but no impact on survival was noticed. Patient summary: The impact of positive surgical margins (PSMs) after partial nephrectomy is a matter of debate. In this study, we found that PSMs were mainly associated with aggressive disease and low surgeon experience.