Document Detail


Importance of surgical margins in the management of renal cell carcinoma.
MedLine Citation:
PMID:  18477995     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Surgical resection remains the standard treatment for clinically localized renal cell carcinoma. Pathological features of the surgical specimen, including the margin status, play an important part in determining the patient's prognosis. Negative surgical margins have traditionally been sought to maximize the efficacy of treatment. Initial concerns that partial nephrectomy might have high local recurrence rates compared with radical nephrectomy have now been minimized as a result of technological advances and refinements in surgical technique. Current concerns in relation to partial nephrectomy include the width of parenchymal tissue that should be removed to avoid positive surgical margins, effects of positive margins on recurrence-free survival, and the use of frozen-section analysis to determine margin status. Size of the surgical margin in partial nephrectomy does not seem to affect the risk of local tumor recurrence, and not all positive surgical margins lead to recurrent disease. Intraoperative frozen-section analysis is not definitive and its value in guiding the surgical management of renal tumors remains to be defined. Laparoscopic partial nephrectomy is emerging as an attractive approach for selected renal masses. Intraoperative use of ultrasound, cold-scissor parenchymal transection, embolization, and hilar clamping to achieve a bloodless operative field with clear visibility, may minimize the risk of positive margins during partial nephrectomy.
Authors:
John S Lam; Jonathan Bergman; Alberto Breda; Peter G Schulam
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Publication Detail:
Type:  Journal Article; Review     Date:  2008-05-13
Journal Detail:
Title:  Nature clinical practice. Urology     Volume:  5     ISSN:  1743-4289     ISO Abbreviation:  -     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-06-06     Completed Date:  2008-07-31     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101226508     Medline TA:  Nat Clin Pract Urol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  308-17     Citation Subset:  IM    
Affiliation:
Department of Urology, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA 90095, USA.
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MeSH Terms
Descriptor/Qualifier:
Carcinoma, Renal Cell / pathology,  surgery*
Humans
Kidney Neoplasms / pathology,  surgery*
Nephrectomy / methods*
Severity of Illness Index
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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