Variation in Surgical Margins Status by Surgical Approach Among Patients Undergoing Partial Nephrectomy for Small Renal Masses

PURPOSE - We assessed the relationship of surgical margins across different surgical approaches to partial nephrectomy for patients with clinical T1a renal cell carcinoma (RCC) from a population-based cohort.

MATERIALS AND METHODS - We used the National Cancer Database to identify all patients who received a partial nephrectomy for clinical T1a RCC (tumor size < 4 cm) from 2010 to 2011. The primary outcome was surgical margin status among patients undergoing partial nephrectomy with either the open, laparoscopic, or robotic approach. Multivariable logistic regression analysis identified patient, hospital, and surgical factors associated with positive surgical margins.

RESULTS - Among 11,587 patients who underwent partial nephrectomy, 44% (n=5,094) had open, 14% (n=1,681) had laparoscopic, and 42% (n=4,812) had robotic. Mean age was 56 (SD: 12 years). Overall, 7% of patients had positive surgical margins (n=806). The positive surgical margins prevalence was 4.9%, 8.1%, and 8.7% for open, laparoscopic, and robotic approaches, respectively (p < 0.001). Laparoscopic (OR: 1.81; p<0.001) and robotic partial nephrectomy (OR: 1.79; p<0.001) had higher adjusted odds ratios for positive surgical margins compared to open. When stratified by hospital type, differences in positive surgical margin rates remained such that patients treated at academic medical centers who underwent laparoscopic (OR 1.38; p = 0.074) or robotic partial nephrectomy (OR 1.73; p <0.001) had higher adjusted odds ratios compared to patients treated with open partial nephrectomy.

CONCLUSIONS - Laparoscopic and robotic partial nephrectomy are associated with higher positive surgical margin rates compared to open partial nephrectomy for clinical T1a renal cell carcinomas. The effect of margin status on long-term oncological outcomes in this context remains to be determined.

J Urol. 2015 Jun 18. pii: S0022-5347(15)04211-1. doi: 10.1016/j.juro.2015.06.076. [Epub ahead of print]

Tabayoyong W1, Abouassaly R2, Kiechle JE1, Cherullo EE3, Meropol NJ4, Shah ND5, Dong S1, Thompson RH6, Smaldone MC7, Zhu H8, Ialacci S3, Kim SP9.

1 University Hospitals Case Medical Center, Case Western Reserve University, Urology Institute, Cleveland, Ohio.
2 University Hospitals Case Medical Center, Case Western Reserve University, Urology Institute, Cleveland, Ohio; University Hospitals Case Medical Center, Center for Health Care Quality and Outcomes, Cleveland Ohio; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, Ohio.
3 University Hospitals Case Medical Center, Case Western Reserve University, Urology Institute, Cleveland, Ohio; University Hospitals Case Medical Center, Center for Health Care Quality and Outcomes, Cleveland Ohio.
4 University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, Ohio; University Hospitals Case Medical Center, Case Western Reserve University, Division of Hematology and Oncology, Cleveland, Ohio.
5 Mayo Clinic, Division of Health Care Policy and Research, Rochester, Minnesota.
6 Mayo Clinic, Department of Urology, Rochester, Minnesota.
7 Fox Chase Cancer Center, Department of Surgical Oncology, Philadelphia, Pennsylvania.
8 Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio; Cleveland Clinic, Department of Urology, Cleveland, Ohio.
9 University Hospitals Case Medical Center, Case Western Reserve University, Urology Institute, Cleveland, Ohio; University Hospitals Case Medical Center, Center for Health Care Quality and Outcomes, Cleveland Ohio; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, Ohio; Yale University, Cancer Outcomes and Public Policy Effectiveness Research (COPPER) Center, Department of Internal Medicine, New Haven, Connecticut.

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