Positive surgical margins after nephron-sparing surgery

Area of Science:

• Urology
• Oncology
• Surgical Pathology

Background:

• The natural history of positive surgical margins (PSMs) following partial nephrectomy (PN) is not well understood.
• Emerging evidence suggests that repeat surgery may not be necessary for all patients with PSMs after PN.

Purpose of the Study:

• To review the incidence and risk factors associated with PSMs after PN.
• To evaluate local and distant disease recurrence rates in patients with PSMs.
• To offer recommendations for preventing and managing PSMs after PN.

Main Methods:

• A non-systematic literature search was conducted using Medline, Scopus, and Web of Science.
• Keywords included "nephron-sparing surgery," "partial nephrectomy," and "margin."
• Included were original research articles on human studies published in English.

Main Results:

• PSM rates vary by surgical approach: 0-7% for open PN, 0.7-4% for laparoscopic PN, and 3.9-5.7% for robot-assisted PN.
• Tumor malignancy combined with PSM increases local recurrence risk.
• Most patients with PSMs do not experience local or distant recurrence, even with intermediate follow-up.

Conclusions:

• Positive surgical margins are uncommon after partial nephrectomy.
• The majority of patients with PSMs after PN remain disease-free, supporting a surveillance strategy over surgical reintervention.