MP21-15 PREDICATIVE FACTORS AND ONCOLOGICAL OUTCOMES OF POSITIVE SURGICAL MARGINS FOLLOWING PARTIAL NEPHRECTOMY- WITH AN EMPHASIS ON SURGICAL EXPERIENCE

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy III (MP21)1 Apr 2020MP21-15 PREDICATIVE FACTORS AND ONCOLOGICAL OUTCOMES OF POSITIVE SURGICAL MARGINS FOLLOWING PARTIAL NEPHRECTOMY- WITH AN EMPHASIS ON SURGICAL EXPERIENCE Yasmin Abu-Ghanem*, Zohar Dotan, Issac Kaver, Dorit Zilberman, Edi Fridman, Jacob Ramon, and Ramat Gan Israel Yasmin Abu-Ghanem*Yasmin Abu-Ghanem* More articles by this author , Zohar DotanZohar Dotan More articles by this author , Issac KaverIssac Kaver More articles by this author , Dorit ZilbermanDorit Zilberman More articles by this author , Edi FridmanEdi Fridman More articles by this author , Jacob RamonJacob Ramon More articles by this author , and Ramat Gan IsraelRamat Gan Israel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000854.015AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The clinical significance of a positive surgical margin (PSM) following partial nephrectomy (PN) remains controversial. The purpose of the current study was to examine the predictive factors for PSM and its association with disease recurrence and mortality following PN for renal-cell carcinoma (RCC). METHODS: Study included 643 patients who underwent partial nephrectomy for RCC between the years 1988-2013. Survival was estimated using the Kaplan-Meier method and was compared with the log-rank test. Cox proportional hazard regression models were used to evaluate the association of PSM with outcome, controlling for clinicopathologic variables. RESULTS: PSM was encountered in 30 (4.7%) patients. On multivariable analysis, tumor size (P=0.01) and central lesions (P=0.04) were found to be associated with PSM. A positive margin was also associated with an increased risk of local recurrence on multivariable analysis (HR 5.8, 95% CI 1.01–33.2, P=0.04). In a stratified analysis based on surgical experience (first 0-150 cases, 150-300, 300-450 and above 450); the rate of PSM significantly decreased over the years (7.1%, 5.2% and 2.4% respectively), but slightly increased again in the last group of case up to 3.8%. Still, the incidence PSM was significantly lower in this group in comparison to the first (P=0.02). Further analysis revealed that patients included in the last group had also significantly larger tumours (P=0.01) and shorter ischemia time (P=0.01). CONCLUSIONS: Lesion size and central renal lesions are independent pre-operative risk factors for PSM in patients undergoing PN. The rate of PSM tends to decrease with increasing experience, yet it is still associated with increased risk of disease recurrence. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e323-e323 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yasmin Abu-Ghanem* More articles by this author Zohar Dotan More articles by this author Issac Kaver More articles by this author Dorit Zilberman More articles by this author Edi Fridman More articles by this author Jacob Ramon More articles by this author Ramat Gan Israel More articles by this author Expand All Advertisement PDF downloadLoading ...