Predictors of Positive Surgical Margins after Robot-Assisted Partial Nephrectomy for Localized Renal Tumors : Insights from a Large Multicenter International Prospective Observational Project (The Surface-Intermediate-Base Margin Score Consortium)
Di Maida, Fabrizio (Unit of Oncologic Minimally-Invasive Urology and Andrology. Department of Experimental and Clinical Medicine. Careggi Hospital)
Campi, Riccardo (Unit of Urological Robotic Surgery and Renal Transplantation. Department of Experimental and Clinical Medicine. University of Florence. Careggi Hospital)
Lane, Brian R. (Department of Urology. Spectrum Health Medical Group)
De Cobelli, Ottavio (Department of Urology. European Institute of Oncology (IEO). University of Milan)
Sanguedolce, Francesco (Fundació Puigvert. Unitat d'Urooncologia)
Hatzichristodoulou, Georgios (Department of Urology. Martha-Maria Hospital Nuremberg)
Antonelli, Alessandro (Department of Urology. University of Verona. Azienda Ospedaliera Universitaria Integrata Verona)
Grosso, Antonio Andrea (Unit of Oncologic Minimally-Invasive Urology and Andrology. Department of Experimental and Clinical Medicine. Careggi Hospital)
Noyes, Sabrina (Department of Urology. Spectrum Health Medical Group)
Rodríguez Faba, Óscar (Institut d'Investigació Biomèdica Sant Pau)
Keeley, Frank X. (Bristol Urological Institute. Southmead Hospital)
Langenhuijsen, Johan (Radboud University Medical Centre. Department of Urology)
Musi, Gennaro (Department of Urology. European Institute of Oncology (IEO). University of Milan)
Klatte, Tobias (Department of Urology. Medical University of Vienna)
Roscigno, Marco (Department of Urology. ASST Papa Giovanni XXIII)
Akdogan, Bulent (Department of Urology. School of Medicine. Hacettepe University)
Furlan, Maria (Department of Urology. University of Brescia)
Simeone, Claudio (Department of Urology. University of Brescia)
Karakoyunlu, Nihat (Department of Urology. Diskapi Yildirim Beyazit Training and Research Hospital)
Marszalek, Martin (Department of Urology. Graz Medical University)
Capitanio, Umberto (Unit of Urology. Division of Experimental Oncology. Urological Research Institute (URI). IRCCS Ospedale San Raffaele)
Volpe, Alessandro (Department of Urology. Maggiore della Carità Hospital. University of Eastern Piedmont)
Brookman-May, Sabine (Janssen Pharma Research and Development)
Gschwend, Jurgen E. (Department of Urology. Rechts der Isar University Hospital. Technical University of Munich)
Smaldone, Marc C. (Division of Urologic Oncology. Fox Chase Cancer Center)
Uzzo, Roberto G. (Division of Urologic Oncology. Fox Chase Cancer Center)
Kutikov, Alexander (Division of Urologic Oncology. Fox Chase Cancer Center)
Minervini, Andrea (Unit of Oncologic Minimally-Invasive Urology and Andrology. Department of Experimental and Clinical Medicine. Careggi Hospital)

Date:	2022
Abstract:	Background: 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. Methods: 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. Results: 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.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Partial nephrectomy ; Positive surgical margins ; Renal tumor ; Robotics ; SIB score
Published in:	Journal of clinical medicine, Vol. 11 Núm. 7 (April 2022) , p. 1765, ISSN 2077-0383

DOI: 10.3390/jcm11071765
PMID: 35407375

10 p, 248.3 KB

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