With nephron sparing surgery, it can, at times, be quite challenging to adhere to this dictum. Furthermore, there are numerous retrospective studies in the literature that suggest that any margin (even less than 1 mm) is adequate for cancer control as long as the cancer is completely excised. Here Timsit and colleagues report on a prospective single institutional study that examines how best to evaluate margins at partial nephrectomy, and what margin is "oncologically adequate".

Nephron sparing surgery was performed on 61 patients over a 4 year period. Mean tumor size was 3.2 cm (range 1.2 - 5). Mean follow-up for the group was 72.5 months. Forty-two patients had clear cell RCC, 17 had papillary RCC, and 2 had chromophobe RCC. No tumor margin was positive in the study. No patient developed metastatic or locoregional relapse in follow-up. The mean peritumoral margin was 7 mm (range 4-10) for the cortex, and 2 mm (range 0-5) for the deepest part of resection. Margins were assessed by the surgeon as well as by frozen section and permanent section analysis and compared. A "complete" margin had a continuous ring of healthy tissue surrounding the lesion. An "incomplete" margin was when the tumor abutted the intact enucleation capsule. Surgeon assessment demonstrated 51 complete and 10 incomplete margins, whereas frozen section and histologic analysis revealed 53 complete and 8 incomplete margins. No relationship was noted between peritumoral margin width and risk of recurrence, even for tumors abutting the hilum where "incomplete" margins are inevitable.

The authors conclude that a negative margin is an oncologic imperative but that any size negative margin should suffice, as there were no recurrences in this study cohort. Furthermore, there was very good concordance between surgeon assessment and histologic assessment regarding margins, however, frozen section is still mandatory if there is any doubt about the margin status.

Urology 67(5): 923-926, 2006.

Written by Christopher G. Wood, MD, a Contributing Editor with UroToday.

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