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Evaluation of the Surgical Margin Threshold for Avoiding Recurrence after Partial Nephrectomy in Patients with Renal Cell Carcinoma

 Jongsoo Lee  ;  Jinu Kim  ;  Jong Chan Kim  ;  Won Sik Ham  ;  Woong Kyu Han  ;  Koon Ho Rha  ;  Young Deuk Choi  ;  Won Sik Jang 
 YONSEI MEDICAL JOURNAL, Vol.63(2) : 173-178, 2022-02 
Journal Title
Issue Date
Carcinoma, Renal Cell* / surgery ; Female ; Humans ; Kidney Neoplasms* / surgery ; Margins of Excision ; Middle Aged ; Neoplasm Recurrence, Local / prevention & control ; Neoplasm Recurrence, Local / surgery ; Nephrectomy ; Retrospective Studies ; Treatment Outcome
Neoplasm recurrence ; kidney cancer ; partial nephrectomy ; retrospective study ; surgical margin
Purpose: An adequate minimal surgical margin for partial nephrectomy (PN) has not yet been conclusively established. Therefore, we aimed to compare PN recurrence rates according to surgical margin status and to establish an adequate minimal surgical margin.

Materials and methods: We retrospectively studied patients with clinically localized renal cell carcinoma who underwent PN between 2005 and 2014. Surgical margin width (SMW) was assessed for all surgical tissues and divided into three groups: SMW <1 mm, SMW ≥1 mm, and positive surgical margin (PSM). The data were analyzed using the Kaplan-Meier method with log-rank tests and multivariate Cox regression models.

Results: Of 748 patients (median age, 55 years; interquartile range, 46-64 years; 220 female), 704 (94.2%) and 44 (5.8%) patients had negative and PSMs, respectively. Recurrence-free survival was significantly lower in patients with PSMs (p<0.001) and was not significantly different between SMW ≥1 mm and <1 mm groups (p=0.604). PSM was a significant predictor of recurrence (hazard ratio: 8.03, 95% confidence interval: 2.74-23.56, p<0.001), in contrast to SMW <1 mm (p=0.680).

Conclusion: A PSM after PN significantly increases the risk of recurrence. We discovered that even a submillimeter safety surgical margin may be enough to prevent recurrence. To maximize normal renal parenchyma preservation and to avoid cancer recurrence in renal parenchymal tumor patients, PN may be a safe treatment, except for those with a PSM in the final pathology.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jong Chan(김종찬) ORCID logo https://orcid.org/0000-0002-0022-6689
Kim, Jinu(김진우)
Rha, Koon Ho(나군호) ORCID logo https://orcid.org/0000-0001-8588-7584
Lee, Jong Soo(이종수) ORCID logo https://orcid.org/0000-0002-9984-1138
Jang, Won Sik(장원식) ORCID logo https://orcid.org/0000-0002-9082-0381
Choi, Young Deuk(최영득) ORCID logo https://orcid.org/0000-0002-8545-5797
Han, Woong Kyu(한웅규) ORCID logo https://orcid.org/0000-0002-2527-4046
Ham, Won Sik(함원식) ORCID logo https://orcid.org/0000-0003-2246-8838
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