Mini-Margin nephron sparing surgery for renal cell carcinoma 4 cm or less

Area of Science:

• Urology
• Oncology
• Surgical Oncology

Background:

• Renal cell carcinoma (RCC) is a common malignancy.
• Nephron sparing surgery (NSS) is preferred for small tumors to preserve renal function.
• Defining optimal surgical margins for NSS is crucial for oncologic control.

Purpose of the Study:

• To evaluate the safety and efficacy of mini-margin NSS for renal cell carcinoma (RCC) measuring 4 cm or less.
• To compare mini-margin NSS with 1 cm-NSS and radical nephrectomy (RN) in early-stage RCC.

Main Methods:

• A comparative study included 389 patients with RCC (≤4 cm) and normal contralateral kidneys.
• Patients were divided into three groups: mini-margin NSS (135 cases), 1 cm-NSS (98 cases), and radical nephrectomy (RN) (156 cases).
• Clinical outcomes and oncologic results were followed up and analyzed.

Main Results:

• Mini-margin NSS had a mean margin width of 2.2 mm, with 83% of cases having margins ≤3 mm. No positive surgical margins were observed in any NSS group.
• The 5-year overall survival rates were 100% for NSS and 98.7% for RN (P = .950).
• Local recurrence occurred in 1.6% of mini-margin NSS patients; no distant metastasis was detected.

Conclusions:

• Mini-margin NSS demonstrates comparable safety and efficacy to 1 cm-NSS and RN for early-stage, localized RCC (≤4 cm).
• This approach offers a viable option for renal preservation in small RCC, achieving excellent oncologic outcomes.