Positive Surgical Parenchymal Margin After Laparoscopic Partial Nephrectomy For Renal Cell Carcinoma: Oncological Outcomes

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology
Article Date: 20 Mar 2007 - 9:00 PDT

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UroToday.com- Positive margins following supposedly curative surgery can be devastating for patient and surgeon alike. The implication that cancer was "left behind" implies a continued biologic threat, although little is known about the impact of positive margins following nephron sparing surgery, because, thankfully, it is a rare finding. Here, two leaders in laparoscopic renal surgery (Gill and Kavoussi) combine their experience to examine oncologic outcomes in patients undergoing laparoscopic partial nephrectomy found to have positive surgical resection margins.

Combined, the two surgeons examined their experience with 511 patients treated with laparoscopic partial nephrectomy with a pathologic diagnosis of renal cell carcinoma. Of these, 9 (1.8%) had positive surgical margins on final pathologic analysis. Interestingly, 8 of the cases had negative margins on frozen section, and in one, margins were not examined through frozen section. In this group, mean tumor size was 2.8 cm (range 1.7-4.0 cm). Two patients had completion nephrectomies at 4 days and 2 months post-partial nephrectomy, respectively. No residual tumor was found in either specimen. The remaining seven patients were observed. Six patients remain disease free with a median follow-up of 32 months (range 6-76 months). One patient, with VHL syndrome, died 10 months after laparoscopic partial nephrectomy with metastatic disease to the pancreas, for an overall recurrence rate of 11%.

The authors conclude that a positive margin after partial nephrectomy does not necessarily indicate residual cancer left behind. Perhaps, thermal therapies such as electrocautery or argon beam, used to assist in hemostasis, may also have some effect in eradicating any residual cancer at the resection site. They emphasize that patients with positive margins, when observed, should be followed closely, as their long term outcome remains unknown, but midterm outcomes appear to mirror those of patients with negative margins.

Permpongkosol S, Colombo Jr. JR, Gill IS, Kavoussi LR
J Urol 176(6): 2401-2404, 2006.

Reviewed by UroToday.com Contributing Editor Christopher G. Wood, MD, FACS

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