Oncological outcomes and prognostic factors after nephron-sparing surgery in renal cell carcinoma.

PURPOSE: To analyse the mid-term oncological results and to asses predictive factors for recurrence and survival after nephron-sparing surgery (NSS) for renal cell carcinoma. MATERIALS AND METHODS: This is a retrospective study that includes 198 Partial Nephrectomies performed at our institution for malignant renal tumours. Demographic information and pathological characteristics were obtained, and completed statistical analysis was performed to assess predictors for overall survival (OS) and overall recurrence in our sample. RESULTS: The presence of positive surgical margins (PSM) in the surgical specimen was reported in 13.6 %. At a median of follow-up of 56.1 months, the non-adjusted cancer-specific mortality, DSS and OS were 100, and 93.4 %, respectively. In the bivariate analysis regarding predictive factors for recurrence, bilaterality and NSS indication (elective or imperative) were statistically significant (p = 0.03 and p = 0.05 respectively). On multivariate analysis only bilaterality was a significant predictor of recurrence (p = 0.03), while high Fuhrman grade was for survival (p = 0.006). CONCLUSION: Our data suggest that patients with bilateral tumours have a higher incidence of local recurrence. Regarding overall survival, our data showed more risk of death at 5 years in those patients with high Fuhrman grade. No differences were found among PSM and negative surgical margins patients regarding oncological outcomes.

Positive margins after nephron-sparing surgery for renal cell carcinoma: long-term follow-up of patients on active surveillance.

OBJECTIVE: To analyse our long-term oncological outcomes with active surveillance in patients with positive surgical margins (PSMs) after nephron-sparing surgery (NSS) for renal cell carcinoma (RCC), as this situation is a difficult therapeutic dilemma. PATIENTS AND METHODS: We performed open NSS for renal masses with frozen-section analysis of any suspicious zone of the surgical bed, followed by extensive argon-beam coagulation. In patients where the final histopathological examination of the renal mass revealed PSMs, follow-up consisted of computed tomography (CT) every 6 months in the first 2 years and then annually up to 5 years, and thereafter we alternated ultrasonography with CT. RESULTS: From 1995 to 2003 we had 11 cases of microscopic definitive PSMs after NSS for RCC. Two patients required nephrectomy (one for postoperative bleeding and another as an elective procedure), so nine were followed. These patients were either operated under elective (seven) or imperative (two) conditions. The histological subtype was clear cell carcinoma in three, papillary in two, chromophobe in two and hybrid oncocytic RCC in two, with a Furhman grade of 2 in six and 3 in three. The mean size was 31.4 mm, and the stage was pT1a in six, pT1b in one and pT3a in two. After a median follow-up of 80.5 months, there was no local recurrence or distant progression. CONCLUSIONS: In our experience, microscopic PSMs in NSS specimens can be managed conservatively with active surveillance, achieving excellent results and avoiding extensive reoperation without compromising long-term oncological outcomes.