Beyond The Abstract - Safety And Efficacy Of Mini-Margin Nephron-Sparing Surgery For Renal Cell Carcinoma 4-cm Or Less

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology;  Clinical Trials / Drug Trials
Article Date: 23 Mar 2008 - 0:00 PST

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UroToday.com - Various surgical techniques are available for nephron-sparing surgery (NSS) in patients with renal cell carcinoma (RCC). However, the size of surgical margin that should be removed with tumor remains controversial. Resection of the tumor with excision of a margin of 1 cm of normal-appearing parenchyma around the tumor has been considered as the standard surgical technique in NSS for many years. However, more recent studies show that the width of the margin is not important, even pure enucleation is as effective as partial nephrectomy with a rim of healthy parenchyma. These studies evoke a tendency to reduction of surgical margin during NSS. The present study was designed to explore whether mini-margin nephron-sparing surgery is clinically safe and effective for RCC 4 cm or less with a normal contralateral kidney.

A total of 115 patients with sporadic, pathologically confirmed RCC 4 cm or less (Stage T1a), with a normal contralateral kidney, were treated by NSS using a mini-margin of less than 5 mm from 1998 to 2006. The surgical margin status was evaluated by both frozen and permanent paraffin section studies including pathologic diagnosis, margin width and possible tumor residual. The maximum and minimal distances from the cut edge of renal parenchyma to tumor pseudocapsule were measured for each case. When there was no renal parenchyma outside pseudocapsule, the margin width was recorded as zero. The patients were followed and clinical results were analyzed with special reports on surgical margin status and patients outcome to evaluate the safety and efficacy of the procedure.

The mean and median tumor diameter was 3.3 and 3.5 cm (range 1.0 to 4.0). None of the patients had positive surgical margins detected at either frozen section or final paraffin section analysis. The minimal margin was always at the bottom of the tumor, where the mean actual margin thickness was 2.2 mm (median, range, 2.0, 0~6). And the maximum margin was always at the area of renal capsule, where the mean actual margin was 4.5 mm (median, range 5.0, 4~6). If taking the minimal margin into analysis only, of the 115 patients, 114 had margins of 5 mm or less (99.1%), 97 (84.3%) had margins of 3 mm or less, and 26 had margins of 0 mm (22.6%). At a mean follow-up of 65 months (median 66, range 9 to 105), all patients were alive. No distant metastasis was detected. Local recurrence was detected in 1 patient (0.9%) at a different site in the kidney. No major surgical complications, such as hemorrhage or urinary leakage/urinoma requiring reoperation, occurred. Considering only the 97 patients with follow-up of more than 3 years in the analysis, the mean and median follow-up time was 73 and 69 months (range 37 to 105), respectively. All 97 patients were alive with no evidence of disease at the last visit.

The results of our study have shown that as long as the tumor is completely excised, a mini-margin (less than 5 mm) nephron sparing surgery is likewise safe and effective in treating early localized renal cell carcinoma 4 cm or less. It provides excellent renal function preservation, favorable long-term progression-free survival, and is not associated with an increased risk of local recurrence.

Written by Quan-lin Li, MD, Liang Cheng, MD, Hong-wei Guan, MD, Yue Zhang, MD, Fa-peng Wang, MD, and Xi-shuang Song MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations, etc., of their research by referencing the published abstract.

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