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.
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.
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.
Journal of clinical medicine. 2022 Mar 23*** epublish ***
Fabrizio Di Maida, Riccardo Campi, Brian R Lane, Ottavio De Cobelli, Francesco Sanguedolce, Georgios Hatzichristodoulou, Alessandro Antonelli, Antonio Andrea Grosso, Sabrina Noyes, Oscar Rodriguez-Faba, Frank X Keeley, Johan Langenhuijsen, Gennaro Musi, Tobias Klatte, Marco Roscigno, Bulent Akdogan, Maria Furlan, Claudio Simeone, Nihat Karakoyunlu, Martin Marszalek, Umberto Capitanio, Alessandro Volpe, Sabine Brookman-May, Jürgen E Gschwend, Marc C Smaldone, Robert G Uzzo, Alexander Kutikov, Andrea Minervini
Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, 50134 Florence, Italy., Unit of Urological Robotic Surgery and Renal Transplantation, Department of Experimental and Clinical Medicine, University of Florence, Careggi Hospital, 50134 Florence, Italy., Department of Urology, Spectrum Health Medical Group, Grand Rapids, MI 49508, USA., Department of Urology, European Institute of Oncology (IEO), University of Milan, 20141 Milan, Italy., Bristol Urological Institute, Southmead Hospital, Bristol BS10 5NB, UK., Department of Urology, Rechts der Isar University Hospital, Technical University of Munich, 81675 Munich, Germany., Department of Urology, University of Brescia, 25121 Brescia, Italy., Uro-Oncology Unit, Fundacio Puigvert, 08025 Barcelona, Spain., Department of Urology, Radboud University Nijmegen Medical Centre, 6525 GA Nijmegen, The Netherlands., Department of Urology, Royal Bournemouth Hospital, Bournemouth BH7 7DW, UK., Department of Urology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy., Department of Urology, School of Medicine, Hacettepe University, Ankara 06800, Turkey., Department of Urology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara 06145, Turkey., Department of Urology and Andrology, Sozialmedizinishes Zentrum Ost-Donauspital, 1220 Vienna, Austria., Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, 20132 Milan, Italy., Department of Urology, Maggiore della Carità Hospital, University of Eastern Piedmont, 28100 Novara, Italy., Department of Urology, Campus Grosshadern, Ludwig-Maximilians University (LMU), 80539 Munich, Germany., Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA.