Positive margins after nephron-sparing surgery for renal cell carcinoma: long-term follow-up of patients on active surveillance.

Abstract:

OBJECTIVE:To analyse our long-term oncological outcomes with active surveillance in patients with positive surgical margins (PSMs) after nephron-sparing surgery (NSS) for renal cell carcinoma (RCC), as this situation is a difficult therapeutic dilemma. PATIENTS AND METHODS:We performed open NSS for renal masses with frozen-section analysis of any suspicious zone of the surgical bed, followed by extensive argon-beam coagulation. In patients where the final histopathological examination of the renal mass revealed PSMs, follow-up consisted of computed tomography (CT) every 6 months in the first 2 years and then annually up to 5 years, and thereafter we alternated ultrasonography with CT. RESULTS:From 1995 to 2003 we had 11 cases of microscopic definitive PSMs after NSS for RCC. Two patients required nephrectomy (one for postoperative bleeding and another as an elective procedure), so nine were followed. These patients were either operated under elective (seven) or imperative (two) conditions. The histological subtype was clear cell carcinoma in three, papillary in two, chromophobe in two and hybrid oncocytic RCC in two, with a Furhman grade of 2 in six and 3 in three. The mean size was 31.4 mm, and the stage was pT1a in six, pT1b in one and pT3a in two. After a median follow-up of 80.5 months, there was no local recurrence or distant progression. CONCLUSIONS:In our experience, microscopic PSMs in NSS specimens can be managed conservatively with active surveillance, achieving excellent results and avoiding extensive reoperation without compromising long-term oncological outcomes.

journal_name

BJU Int

journal_title

BJU international

authors

Lopez-Costea MA,Fumadó L,Lorente D,Riera L,Miranda EF

doi

10.1111/j.1464-410X.2009.09174.x

subject

Has Abstract

pub_date

2010-09-01 00:00:00

pages

645-8

issue

5

eissn

1464-4096

issn

1464-410X

pii

BJU9174

journal_volume

106

pub_type

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