Document Detail


Positive Surgical Margins After Nephron-Sparing Surgery.
MedLine Citation:
PMID:  22136987     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
CONTEXT: Little is known on the natural history of positive surgical margins (PSMs) in partial nephrectomy (PN). Accumulating data suggest that secondary nephrectomy might not be necessary in all patients with PSMs after PN. OBJECTIVE: Provide an overview on incidence and risk factors for PSMs after partial nephrectomy and on the rate of local and distant disease recurrence related to PSMs. We also provide recommendations on how to avoid and how to treat PSMs after PN. EVIDENCE ACQUISITION: A nonsystematic literature research was based on Medline, Scopus, and Web of Science queries on these keywords: nephron-sparing surgery, partial nephrectomy/ies, and margin. Only human studies (original research) published in English were included. EVIDENCE SYNTHESIS: PSMs are present in 0-7% of patients after open PN, in 0.7-4% after laparoscopic PN, and in 3.9-5.7% after robot-assisted PN. The thickness of healthy parenchyma surrounding the tumour is irrelevant as long as complete tumour removal is achieved. The coincidence of a highly malignant tumour and PSM increases the risk of local recurrence. Intermediate follow-up data indicate that the vast majority of patients with PSMs will not experience local or distant tumour recurrence. Frozen-section analysis for evaluation of resection margins during PN is of minor clinical significance, as the surgeon's gross assessment of macroscopically negative margins provides reliable results. CONCLUSIONS: PSMs in PN are rare. As indicated by intermediate follow-up data, the majority of patients with PSMs after PN remain without disease recurrence, and a surveillance strategy seems preferable to surgical reintervention.
Authors:
Martin Marszalek; Marco Carini; Piotr Chlosta; Klaus Jeschke; Ziya Kirkali; Ruth Knüchel; Stephan Madersbacher; Jean-Jacques Patard; Hendrik Van Poppel
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-11-24
Journal Detail:
Title:  European urology     Volume:  -     ISSN:  1873-7560     ISO Abbreviation:  -     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-12-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7512719     Medline TA:  Eur Urol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011. Published by Elsevier B.V.
Affiliation:
Department of Urology and Andrology, Donauspital, Vienna, Austria; Department of Urology, Graz Medical University, Graz, Austria.
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