Washington, DC (UroToday.com) In the SUO meeting poster session Alexander Kutikov and colleagues from the Fox Chase Cancer Center presented their data on partial nephrectomy resection techniques. Resection methodology during Nephron Sparing Surgery (NSS) is rarely reported. Yet, a relationship between technique and complication rates, preserved parenchymal volume, surgical margins, local recurrence, and oncologic outcomes likely exists. As such, the
authors set out to prospectively collect data on partial nephrectomy resection techniques harnessing the newly proposed S.I.B. Margin Score from high-volume Centers across the U.S. and Europe. 16 centers from the United States and Europe enrolled patients into the study over a 6 month enrollment period (n=507). 90 of these patients were from University of Florence, an Institution that intentionally performs all NSS with an enucleative resection strategy. A mix of open (150, 29.4%), laparoscopic (67, 13.2%) and robotic (290, 57%) approaches were harnessed for NSS, employing the off-clamp strategy in 119 (23.5%) of patients. Median tumor size was 3.1 cm (IQR 2.50 – 4.30). Based on a nephrometric anatomic tumor complexity scoring, 195 (38,5%), 188 (37,1%) and 114 (22.5%) tumors were classified as low, moderate and high complexity, respectively. At histopathological analysis, 30 (5.9%) positive surgical margins were recorded. Each Institution contributed a mean of 32 cases (range 11-90). Pure enucleation was the most common strategy employed for resection even when the data from the University of Florence (an institution that openly prefers enucleation) were excluded. The authors concluded that standardized reporting of resection technique during NSS is lacking in the Urologic literature. The authors recently introduced a standardized scoring system, the S.I.B. Margin score, which quantitates the salient aspects of resection approaches after NSS through a visual analysis of the intrarenal portion of the specimen. Harnessing this systematic characterization of renal mass resection techniques, we for the first time demonstrate in an international multi-institutional cohort that resection approaches vary and that renal tumor enucleation is employed quite frequently even at institutions that do not support its ubiquitous use. These data lay the groundwork for determining whether resection technique is a modifiable variable for functional and oncologic.
Fox Chase Cancer Center
Dr. Miki Haifler, MD. from the Society of Urologic Oncology Meeting - December 2 - 4, 2015 – Washington, DC.
Fox Chase Cancer Center