Márgenes positivos tras nefrectomía parcial en carcinoma de células renales: seguimiento a largo plazo y resultados oncológicos con manejo conservador / Positive margins after partial nephrectomy in renal cell carcinoma: Oncological outcomes of conservative management after long-term follow-up

Introducción: La nefrectomía parcial (NP) es el tratamiento de elección para el tumor renal pequeño y localizado (cT1). Uno de los puntos de debate respecto a esta técnica es el manejo de los márgenes de resección afectados/positivos (MP). Presentamos los resultados oncológicos a largo plazo en pacientes con MP tras NP manejados conservadoramente. Material y métodos: En nuestro centro entre el año 1990 y 2011 se realizaron 207 NP, de las cuales 17 tuvieron MP. Dos pacientes fueron excluidos del estudio por nefrectomía radical posterior. El seguimiento se realizó con tomografía computarizada cada 6 meses en los primeros 2 años y luego anualmente. La supervivencia cáncer-específica y supervivencia libre de enfermedad fueron calculadas con el método de Kaplan-Meier. Resultados: La mediana de edad fue de 62 años (RIQ: 55-71) y el tamaño tumoral promedio fue de 34,8 (10-77) mm. Los resultados histopatológicos fueron: 6 (40%) CCR de células claras, 4 (26,7%) papilares, 3 (20%) cromófobos y 2 (13,3%) oncocíticos. Los estadios histopatológicos fueron: 11 (73,3%) pT1a, 1 (6,7%) pT1b y 3 (20%) pT3a. La mediana de seguimiento fue de 84 meses (RIQ 72-120). Dos pacientes presentaron recidiva metastásica y muerte a causa de la misma. El primero recidivó a los 112 meses y el segundo a los 59. La supervivencia cáncer-específica a 5 años fue de 87,5% y la supervivencia libre de enfermedad a 5 años fue de 93,3%. Conclusiones: En nuestra experiencia, pacientes con MP tras NP pueden ser manejados de manera conservadora, obteniendo resultados oncológicos aceptables a largo plazo

Introduction: Partial nephrectomy (PN) is the standard treatment for small and localized kidney tumours (cT1). One of the controversial aspects regarding this technique is the management of affected/positive resection margins. We present the long-term oncological results in patients with PSM after PN managed conservatively. Material and methods: There were 207 PN performed in our centre between 1990 and 2011. 17 patients presented PSM. 2 patients were excluded from the study due to completion nephrectomy afterwards. Follow-up was was done with abdominal contrast-enhanced computed tomography every 6 months for the first 2 years and subsequently, once a year. Cancer-specific survival and disease-free survival were calculated with the Kaplan-Meier method. Results: The median age was 62 years (RIQ: 55-71) and the mean tumour size was 34.8 (10-77) mm. Histopathological results were: 6 (40%) clear cell RCC, 4 (26.7%) papillary, 3 (20%) chromophobe and 2 (13.3%) oncocytic. The pathologic stages were: 11 (73.3%) pT1a, 1 (6.7%) pT1b and 3 (20%) pT3a. The median follow-up was 84 months (IQR 72-120). 2 patients had metastatic recurrence and this was the cause of death. The first one had recurrence at 112 months and the second one at 59. 5-year CSS and RFS were 87.5% and 93.3% respectively. Conclusions: In our experience, patients with PSM after PN can be managed conservatively with satisfactory long-term oncological outcomes

Positive margins after partial nephrectomy in renal cell carcinoma: Oncological outcomes of conservative management after long-term follow-up. / Márgenes positivos tras nefrectomía parcial en carcinoma de células renales: seguimiento a largo plazo y resultados oncológicos con manejo conservador.

INTRODUCTION: Partial nephrectomy (PN) is the standard treatment for small and localized kidney tumours (cT1). One of the controversial aspects regarding this technique is the management of affected/positive resection margins. We present the long-term oncological results in patients with PSM after PN managed conservatively. MATERIAL AND METHODS: There were 207 PN performed in our centre between 1990 and 2011. 17 patients presented PSM. 2 patients were excluded from the study due to completion nephrectomy afterwards. Follow-up was was done with abdominal contrast-enhanced computed tomography every 6 months for the first 2 years and subsequently, once a year. Cancer-specific survival and disease-free survival were calculated with the Kaplan-Meier method. RESULTS: The median age was 62 years (RIQ: 55-71) and the mean tumour size was 34.8 (10-77) mm. Histopathological results were: 6 (40%) clear cell RCC, 4 (26.7%) papillary, 3 (20%) chromophobe and 2 (13.3%) oncocytic. The pathologic stages were: 11 (73.3%) pT1a, 1 (6.7%) pT1b and 3 (20%) pT3a. The median follow-up was 84 months (IQR 72-120). 2 patients had metastatic recurrence and this was the cause of death. The first one had recurrence at 112 months and the second one at 59. 5-year CSS and RFS were 87.5% and 93.3% respectively. CONCLUSIONS: In our experience, patients with PSM after PN can be managed conservatively with satisfactory long-term oncological outcomes.