Oncologic Outcomes For Patients With Positive Surgical Margins At Partial Nephrectomy

Main Category: Urology / Nephrology
Article Date: 21 Jun 2008 - 1:00 PDT

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ORLANDO, FL (UroToday.com) - Dr Thompson presented the long-term oncologic outcomes for patients with positive surgical margin (PSM) following partial nephrectomy.

1,344 patients who underwent partial nephrectomy at Memorial Sloan-Kettering or Mayo Clinic between 1972 and 2005 were identified. All data were obtained from prospectively maintained databases. The median overall follow-up was 3.4 years, including 459 (33%) patients who were followed for > 5 years and 136 (10.1%) who were followed for >10 years. PSMs were documented on the final pathology in 77 cases (5.5%) and all cases were managed expectantly. Intraoperatively, the tumor was felt to be completely excised in all cases. At last follow-up, local recurrence and metastatic progression occurred in 39 (2.9%) and 57 (4.2%) patients, respectively. The estimated 5-year freedom from a local recurrence was 98% and 97% for patients with PSM and patients with negative margins, respectively (p=0.97). The 10-year freedom from metastatic disease was 95% and 93% for patients with PSM and patients with negative margins, respectively (p=0.18).

When looking at a multivariate analysis adjusting for tumor size, pathologic stage, histologic subtype, and presence of a solitary kidney, PSM were NOT associated with local recurrence (hazard ratio 1.0, p=0.99) or subsequent metastatic disease (hazard ratio 1.6, p=0.36). It appears from this data in a very large number of patients with long-term follow-up that PSM after partial nephrectomy do not uniformly portend an adverse prognosis.

The goal of nephron-sparing surgery clearly should be complete tumor excision with a negative margin, however, it appears that selected patients with a grossly negative margin during excision but a positive margin on the final pathology can be safely offered vigilant monitoring without compromising their long-term disease-free survival.

Presented by R Houston Thompson, MD, et al., at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor Geoff Box, MD

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