We systematically evaluated the impact of positive surgical margins (PSM) on oncological outcomes after partial nephrectomy for renal cell carcinoma. Forty two studies comprising 101,153 subjects were included and 5 distinct meta-analyses were performed. PSM was associated with increased risk of local recurrence (HR 6.11 - high certainty), metastasis (HR 3.29 - moderate certainty), overall relapse (HR 2.25 - high certainty), overall mortality (HR 1.30 - moderate certainty), and may be associated with increased cancer-specific mortality (HR 1.91 - low certainty). Patients with PSM should be counselled for the possibility of additional surgery, novel adjuvant therapies, and more rigorous surveillance.
Urology. 2021 Jun 26 [Epub ahead of print]
Nizar Hakam, Nassib Abou Heidar, Joanne Khabsa, Layal Hneiny, Elie A Akl, Raja Khauli
Division of Urology and Renal Transplantation, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon; The Breyer Urology Research Laboratory, Zuckerberg San Francisco General, University of California San Francisco, San Francisco, California, USA. Electronic address: ., Division of Urology and Renal Transplantation, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: ., Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: ., Saab Medical Library, University Libraries, American University of Beirut, Beirut, Lebanon. Electronic address: ., Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon; Department of Internal Medicine, American University of Beirut, Beirut, Lebanon. Electronic address: ., Division of Urology and Renal Transplantation, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: .