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Positive Surgical Margins After Robot-Assisted Partial Nephrectomy Predict Long-Term Oncologic Outcomes for

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  • 1School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA.

Journal of Endourology
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Summary

Positive surgical margins (PSMs) after robotic partial nephrectomy (RPN) significantly increase renal mass recurrence risk but do not impact overall survival. This study highlights the importance of margin status in RPN outcomes.

Keywords:
follow-upnephrectomyrenal cell carcinomarobotic surgerysurgical margins

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Area of Science:

  • Urology
  • Oncology
  • Surgical Innovation

Background:

  • Positive surgical margins (PSMs) in renal mass resection are debated regarding their impact on recurrence and survival.
  • Long-term data on PSM after robotic partial nephrectomy (RPN) is limited, creating uncertainty about its clinical significance.

Purpose of the Study:

  • To evaluate the long-term survival outcomes after RPN in patients with clinically localized renal masses, specifically examining the impact of surgical margin status.

Main Methods:

  • A retrospective review of 374 patients who underwent RPN for clinically localized renal masses between June 2007 and December 2012.
  • Disease recurrence and overall survival (OS) were analyzed based on the presence or absence of PSMs.
  • Patient and tumor characteristics associated with PSMs were identified.

Main Results:

  • PSMs were identified in 3.2% of patients (12/374).
  • Patients with PSMs faced a 14-fold increased risk of recurrence (p < 0.001) but showed no significant difference in OS (p = 0.130).
  • PSMs were associated with higher rates of chronic obstructive pulmonary disease (COPD) and greater blood loss during surgery.

Conclusions:

  • In patients undergoing RPN for localized renal masses, PSMs substantially elevate the risk of disease recurrence over an extended follow-up period (mean 77.7 months) without affecting overall survival.
  • Further research in larger cohorts is needed to confirm the association between PSMs, COPD, and increased blood loss.