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AUA 2017

AUA 2017: Surgical Approach Does Not Impact Positive Margin Rate in Partial Nephrectomy for Large Renal Masses

Boston, MA (UroToday.com) Dr. Abimbola Ayangbesan stated that renal cell carcinoma is the 6th most common cancer in men and the standard of care for most ct1 tumors is partial nephrectomy. Over the past decade there has been an increase in the utilization of partial nephrectomy in the management of renal masses. Additionally, the minimally invasive approach has been gaining increasing prominence in the last few years. Ultimately the main goal, of partial nephrectomy is complete removal with the attainment of cancer free margins. While surgical approach has been associated with positive surgical margins in partial nephrectomy for small renal masses (<4 cm), its impact on margin status for large renal masses is unclear.
Given the limited literature evaluating the positive partial nephrectomy and margin status for large renal masses Dr. Ayangbesan sought to evaluate the relationship between positive surgical margins and surgical approach in partial nephrectomy for large renal masses, greater than 4cm. He also sought to identify independent factors associated with positive margin and assessed the impact of positive margins on overall patient survival.

Dr. Ayangbesan used the National cancer database to identify approximately 7500 patients from 2011 to 2013. The primary outcome for their evaluation was surgical margin status. Multivariable regression modeling was performed to identify patient, facility, and surgical factors, including surgical approach (open, laparoscopic, or robotic) on positive surgical margins in patients undergoing the partial nephrectomy procedure.

Of the approximately 7500 patients assessed 6.72% had positive surgical margins. Additionally analysis showed that age, African American race, education, rural setting, mixed histology, undifferentiated tumor grade, as well as having surgery performed at a non-academic facility were associated with positive surgical margins. However, surgical approach and stage were not associated with positive surgical margins.

Dr. Ayangbesan concluded that surgical approach is not independently associated with increased risk of PSM for large renal masses. Lastly, surgery at an academic facility was not associated with a positive margin.

Presented By: Abimbola Ayangbesan

Authors: Abimbola Ayangbesan, David Golombos,Padraic O'Malley, Patrick Lewicki, LaMont Barlow, Xian Wu, Paul Christos, Douglas Scherr

Affiliation: : New York, NY

Written By: Renai Yoon, MD, Department of Urology, University of California-Irvine

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA