Presentation Authors: Andrea Mari*, Riccardo Tellini, Riccardo Campi, Firenze, Italy, Riccardo Schiavina, Bologna, Italy, Daniele Amparore, Orbassano, Torino, Italy, Alessandro Antonelli, Brescia, Italy, Maurizio Barale, Torino, Italy, Roberto Bertini, Milano, Italy, Marco Borghesi, Bologna, Italy, Pierluigi Bove, Roma, Italy, Eugenio Brunocilla, Bologna, Italy, Umberto Capitanio, Milano, Italy, Luigi Da Pozzo, Bergamo, Italy, Paolo Gontero, Torino, Italy, Nicola Longo, Naples, Italy, Emanuele Montanari, Milano, Italy, Francesco Porpiglia, Orbassano, Torino, Italy, Sergio Serni, Florence, Italy, Claudio Simeone, Brescia, Italy, Salvatore Siracusano, Verona, Italy, Carlo Trombetta, Trieste, Italy, Alessandro Volpe, Novara, Italy, Vincenzo Ficarra, Messina, Italy, Marco Carini, Andrea Minervini, Firenze, Italy
Introduction: To assess the positive surgical margin (PSM) rate and to investigate for its predictors in patients treated with partial nephrectomy (PN) for localized renal tumors in a large multicenter prospective observational study.
Methods: We prospectively evaluated 4308 patients who underwent surgical treatment for renal tumors between January 2013 and December 2016 at 26 urological Italian centres (the RECORd 2 project). PSM was assigned at pathological examination if the tumor tissue was marked with ink. Uni and multivariable analyses were fitted to identify independent predictors of PSM.
Results: Overall, 2076 patients treated with PN for localized renal cell carcinoma (RCC) were included. Median age was 62.6 (IQR: 54.7â€“72) and 69.5% (1443/2076) were males. Median PADUA score was 8 (IQR: 7-9). Simple enucleation (SE) and enucleoresection (ER) were performed in 722 (34.8%) and 1354 (65.2%) respectively. 1461 (70.4%), 405 (19.5%), 191 (9.2%) 2 (0.09%) and 17 (0.8%) had clear cell RCC, papillary RCC, chromophobe RCC, sarcomatoid RCC and unclassified RCC respectively. Upstaging to pT3a and lymphovascular invasion (LVI) were recorded in 164 (7.9%) and 95 (4.6%). Tumor necrosis and sarcomatoid differentiation were recorded in 342 (16.5%) and 22 (1.1%) with a median percentage of 30% (IQR 15%-65%) and 35% (IQR 15%-70%) within the tumor, respectively. PSM were recorded in 155 (4.9%) patients. At the multivariable analysis, Charlson comorbidity index (CCI) (OR: 1.01; 95% CI: 1.016-1.189; p=0.018), laparoscopic (OR:1.56; 95% CI 1.05-2.33; p=0.03) versus open surgical approach, ER (OR:1.69; 95% CI 1.11-2.58; p=0.014) vs SE, lymphovascular invasion (OR: 2.04; 95% CI 1.12-3.70; p=0.02) and tumor upstaging (OR: 2.61; 95% CI 1.63-4.16; p < 0.001) were significant predictive factors of PSM. Conversely, hilar clamping, robotic versus open approach and PADUA score were significantly associated with PSM, but were not independent at multivariable analysis.
Conclusions: The early oncological goal of PN is to achieve negative margins. In our multi-institutional report, CCI, laparoscopic approach, enucleoresection technique, lymphovascular invasion and tumor upstaging were independent predictors of PSM in patients treated with PN for localized RCC.