Positive surgical margin’s impact on short-term oncological prognosis after robot-assisted partial nephrectomy (MARGINS study: UroCCR no 96)

oleh: Arnoult Morrone, Imad Bentellis, Jean-Christophe Bernhard, Karim Bensalah, Cécile Champy, Franck Bruyere, Nicolas Doumerc, Jonathan Olivier, François Audenet, Bastien Parier, Martin Brenier, Jean-Alexandre Long, François-Xavier Nouhaud, Nicolas Branger, Hervé Lang, Thomas Charles, Evanguelos Xylinas, Thibaut Waeckel, Florie Gomez, Romain Boissier, Benjamin Rouget, Aysha Shaikh, Daniel Chevallier, Damien Ambrosetti, Matthieu Durand

Format: Article
Diterbitkan: Nature Portfolio 2022-10-01

Deskripsi

Abstract The oncological impact of positive surgical margins (PSM) after robot-assisted partial nephrectomy (RAPN) is still under debate. We compared PSM and Negative Surgical Margins (NSM) in terms of recurrence-free survival (RFS), metastasis-free survival (MFS) and overall survival (OS) after RAPN, and we identified predictive factors of PSM. Multi-institutional study using the UroCCR database, which prospectively included 2166 RAPN between April 2010 and February 2021 (CNIL DR 2013-206; NCT03293563). Two groups were retrospectively compared: PSM versus NSM. Prognostic factors were assessed using Kaplan–Meyer curves with log-Rank test, cox hazard proportional risk model and logistic regression after univariate comparison. 136 patients had PSM (6.3%) and 2030 (93.7%) had NSM. During a median follow-up of 19 (9–36) months after RAPN, 160 (7.4%) recurrences were reported. Kaplan–Meier curves and analysis suggested that RFS, MFS and OS were not affected by a PSM (p = 0.68; 0.71; 0.88, respectively). In multivariate analysis predictors of PSM were a lower RENAL score (p = 0.001), longer warm ischemia time (WIT) (p = 0.003) and Chromophobe Renal Cell Carcinoma (chrRCC) (p = 0.043). This study found no impact of PSM on RFS, MFS or OS, and predictors of PSM were the RENAL score, WIT and chrRCC.