Impact of Positive Surgical Margins After Partial Nephrectomy

João André Mendes Carvalho; Pedro Nunes; Edgar Tavares-da-Silva; Belmiro Parada; Roberto Jarimba; Pedro Moreira; Edson Retroz; Rui Caetano; Vítor Sousa; Augusta Cipriano; Arnaldo Figueiredo

doi:10.1016/j.euros.2020.08.006

Impact of Positive Surgical Margins After Partial Nephrectomy

Eur Urol Open Sci. 2020 Oct 2:21:41-46. doi: 10.1016/j.euros.2020.08.006. eCollection 2020 Oct.

Authors

João André Mendes Carvalho^{1

2}, Pedro Nunes^{1

2}, Edgar Tavares-da-Silva^{1

2}, Belmiro Parada^{1

2}, Roberto Jarimba¹, Pedro Moreira¹, Edson Retroz¹, Rui Caetano³, Vítor Sousa^{2

3}, Augusta Cipriano^{2

3}, Arnaldo Figueiredo^{1

2}

Affiliations

¹ Department of Urology and Renal Transplantation, Coimbra University Hospital Center, Coimbra, Portugal.
² Faculty of Medicine, Coimbra University, Coimbra, Portugal.
³ Department of Pathology, Coimbra University Hospital Center, Coimbra, Portugal.

Abstract

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.

Keywords: Laparoscopy; Nephrectomy; Positive surgical margins.