Predictors of Positive Surgical Margins after Robot-Assisted Partial Nephrectomy for Localized Renal Tumors

Background: To explore predictors of positive surgical margins (PSM) after robotic partial nephrectomy (PN) in a large multicenter international observational project, harnessing the Surface-Intermediate-Base (SIB) margin score to report the resection technique after PN in a standardized way. Method...

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Detalles Bibliográficos
Autores: Di Maida, Fabrizio, Campi, Riccardo|||0000-0001-5237-0888, Lane, Brian R., De Cobelli, Ottavio, Sanguedolce, Francesco|||0000-0002-5242-7060, Hatzichristodoulou, Georgios|||0000-0002-3170-7362, Antonelli, Alessandro|||0000-0002-7455-8803, Grosso, Antonio Andrea, Noyes, Sabrina, Rodríguez Faba, Óscar|||0000-0001-6668-4423, Keeley, Frank X., Langenhuijsen, Johan, Musi, Gennaro, Klatte, Tobias, Roscigno, Marco, Akdogan, Bulent, Furlan, Maria, Simeone, Claudio, Karakoyunlu, Nihat, Marszalek, Martin, Capitanio, Umberto, Volpe, Alessandro, Brookman-May, Sabine, Gschwend, Jurgen E., Smaldone, Marc C., Uzzo, Roberto G., Kutikov, Alexander, Minervini, Andrea
Tipo de recurso: artículo
Fecha de publicación:2022
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:277713
Acceso en línea:https://ddd.uab.cat/record/277713
https://dx.doi.org/urn:doi:10.3390/jcm11071765
Access Level:acceso abierto
Palabra clave:Partial nephrectomy
Positive surgical margins
Renal tumor
Robotics
SIB score
Descripción
Sumario:Background: To explore predictors of positive surgical margins (PSM) after robotic partial nephrectomy (PN) in a large multicenter international observational project, harnessing the Surface-Intermediate-Base (SIB) margin score to report the resection technique after PN in a standardized way. Methods: Data from consecutive patients with cT1-2N0M0 renal masses treated with PN from September 2014 to March 2015 at 16 tertiary referral centers and included in the SIB margin score International Consortium were prospectively collected. For the present study, only patients treated with robotic PN were included. Uni-and multivariable analysis were fitted to explore clinical and surgical predictors of PSMs after PN. Results: Overall, 289 patients were enrolled. Median (IQR) preoperative tumor size was 3.0 (2.3-4.2) cm and median (IQR) PADUA score was 8 (7-9). SIB scores of 0-2 (enucleation), 3-4 (enucleoresection) and 5 (resection) were reported in 53.3%, 27.3% and 19.4% of cases, respectively. A PSM was recorded in 18 (6.2%) patients. PSM rate was 4.5%, 11.4% and 3.6% in case of enucleation, enucleoresection and resection, respectively. Patients with PSMs had tumors with a higher rate of contact with the urinary collecting system (55.6% vs. 27.3%; p < 0.001) and a longer median warm ischemia time (22 vs. 16 min; p = 0.02) compared with patients with negative surgical margins, while no differences emerged between the two groups in terms of other tumor features (i.e., pathological diameter, PADUA score). In multivariable analysis, only enucleoresection (SIB score 3-4) versus enucleation (SIB score 0-2) was found to be an independent predictor of PSM at final pathology (HR: 2.68; 95% CI: 1.25-7.63; p = 0.04), while resection (SIB score 5) was not. Conclusions: In our experience, enucleoresection led to a higher risk of PSMs as compared to enucleation. Further studies are needed to assess the differential impacts of resection technique and surgeon's experience on margin status after robotic PN.

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