Surgical Approach Does Not Impact Margin Status After Partial Nephrectomy for Large Renal Masses

Area of Science:

• Urology
• Surgical Oncology
• Renal Cell Carcinoma Research

Background:

• Positive surgical margins (PSM) after partial nephrectomy (PN) are linked to surgical approach for small renal masses.
• The impact of surgical approach on PSM for larger renal masses remains unclear.

Purpose of the Study:

• To evaluate the relationship between surgical approach and margin status in patients undergoing PN for large renal masses (>4cm).
• To determine if tumor size influences PSM in the context of different surgical approaches.

Main Methods:

• Analysis of the National Cancer Database (NCDB) for patients with pT1b and pT2a renal cell carcinoma undergoing PN (2010-2013).
• Inclusion of conversions to open surgery.
• Multivariable regression and propensity score matching to assess factors associated with PSM and overall survival (OS).

Main Results:

• No significant association was found between surgical approach (laparoscopic/robotic vs. open) and PSM (p=0.12 and p=0.44, respectively).
• Tumor stage (T2a vs. T1b) was not significantly associated with PSM (p=0.18).
• PSM did not significantly impact overall survival (HR 0.95; p=0.88).

Conclusions:

• Surgical approach is not associated with an increased risk of PSM for large, noninvasive renal masses.
• Tumor size (T1b to T2a) does not increase the risk of PSM.
• Surgeon comfort level, rather than tumor size, should guide the selection of surgical approach for partial nephrectomy.