San Antonio, Texas USA (UroToday.com) Nephron Sparing Surgery (NSS) has become the gold standard treatment for T1a RCC and select T1b cases. In the last few years minimally invasive (MIS) approaches for NSS have been adopted. The use of MIS for NSS has been shown to be safe but the presence of positive surgical margins (PSM) has been associated with worse oncological outcomes.
The authors sought to define the occurrence of PSM in different NSS approaches and in different hospital volumes.
The National Cancer Data Base (NCDB) was used as the data source. 30711 patients with non-metastatic kidney cancer smaller than 8 cm that underwent NSS were included. These patients were divided into 3 groups according to the surgical approach.
From 2010 to 2013 the proportion of robotic NSS increased while the proportion of open and laparoscopic NSS decreased. The prevalence of PSM was higher for low volume centers (4.44% and 8.86% for centers with more than 39 and less than 9 cases per year respectively). PSM was found in 5.6%, &.6% and 8.42% of cases with open, laparoscopic and robotic approaches respectively (p<0.001). Factors that were found to predict PSM on multivariable analysis include black race, tumor size smaller than 6 mm, low volume centers and MIS approaches. Hospital location (urban or rural) was predictive of PSM.
The authors conclude that these risk factors need to be considered when performing NSS, especially due to the ubiquitous use of robotic NSS.
Written By: Miki Haifler, MD, SUO Fellow, Fox Chase Cancer Center
17th Annual Meeting of the Society of Urologic Oncology - November 30 -December 2, 2016 – San Antonio, Texas USA