Editorial Comment

Abstract

The authors present data regarding the limited effect of a positive parenchymal margin during partial nephrectomy on cancer-specific outcomes. Despite the finding of a positive margin in 17 patients (15%), only 2 of 13 sites assessed pathologically by either repeat resection or nephrectomy were found to contain residual cancer. None of these 17 patients experienced a recurrence or death due to renal cancer. These data agree with several other recent publications indicating that positive margins during partial nephrectomy have limited effect on cancer-specific outcomes. 1 Yossepowitch O. Thompson R.H. Leibovich B.C. et al. Positive surgical margins at partial nephrectomy: predictors and oncological outcomes. J Urol. 2008; 179: 2158-2163 Abstract Full Text Full Text PDF PubMed Scopus (232) Google Scholar , 2 Kwon E.O. Carver B.S. Snyder M.E. et al. Impact of positive surgical margins in patients undergoing partial nephrectomy for renal cortical tumours. BJU Int. 2007; 99: 286-289 Crossref PubMed Scopus (113) Google Scholar , 3 Permpongkosol S. Colombo J.R. Gill I.S. et al. Positive surgical parenchymal margin after laparoscopic partial nephrectomy for renal cell carcinoma: oncological outcomes. J Urol. 2006; 176: 2401-2404 Abstract Full Text Full Text PDF PubMed Scopus (125) Google Scholar Although recent data indicate that enucleation (tumor resection without a margin) provides excellent oncologic outcomes, 4 Carini M. Minervini A. Masieri L. et al. Simple enucleation for the treatment of PT1a renal cell carcinoma: our 20-year experience. Eur Urol. 2006; 50 (discussion: 1269-1271): 1263-1268 Abstract Full Text Full Text PDF PubMed Scopus (101) Google Scholar we believe that the goal of partial nephrectomy is complete tumor resection with a minimal rim of normal parenchyma. 5 Castilla E.A. Liou L.S. Abrahams N.A. et al. Prognostic importance of resection margin width after nephron-sparing surgery for renal cell carcinoma. Urology. 2002; 60: 993-997 Abstract Full Text Full Text PDF PubMed Scopus (143) Google Scholar We agree with the authors' conclusion that in a majority of cases, a positive margin should not prompt immediate or delayed radical nephrectomy. Positive Surgical Margins With Renal Cell Carcinoma Have a Limited Influence on Long-term Oncological Outcomes of Nephron Sparing SurgeryUrologyVol. 75Issue 2PreviewTo define the rate of positive surgical margins (PSMs) and analyze the outcome of patients with PSMs. The outcome and proper management of patients with positive PSMs during nephron sparing surgery (NSS) are questionable. In this study we define the clinical outcomes of PSMs at NSS and suggest management. Full-Text PDF