Predictors of Positive Surgical Margins after Robot-Assisted Partial Nephrectomy for Localized Renal Tumors: Insights from a Large Multicenter International Prospective Observational Project (The Surface-Intermediate-Base Margin Score Consortium)
Por:
Di Maida, F, Campi, R, Lane, BR, De Cobelli, O, Sanguedolce, F, Hatzichristodoulou, G, Antonelli, A, Grosso, AA, Noyes, S, Rodriguez-Faba, O, Keeley, FX, Langenhuijsen, J, Musi, G, Klatte, T, Roscigno, M, Akdogan, B, Furlan, M, Simeone, C, Karakoyunlu, N, Marszalek, M, Capitanio, U, Volpe, A, Brookman-May, S, Gschwend, JE, Smaldone, MC, Uzzo, RG, Kutikov, A, Minervini, A
Publicada:
1 abr 2022
Resumen:
Background: To explore predictors of positive surgical margins (PSM) after robotic partial nephrectomy (PN) in a large multicenter international observational project, harnessing the Surface-Intermediate-Base (SIB) margin score to report the resection technique after PN in a standardized way. Methods: Data from consecutive patients with cT1-2N0M0 renal masses treated with PN from September 2014 to March 2015 at 16 tertiary referral centers and included in the SIB margin score International Consortium were prospectively collected. For the present study, only patients treated with robotic PN were included. Uni- and multivariable analysis were fitted to explore clinical and surgical predictors of PSMs after PN. Results: Overall, 289 patients were enrolled. Median (IQR) preoperative tumor size was 3.0 (2.3-4.2) cm and median (IQR) PADUA score was 8 (7-9). SIB scores of 0-2 (enucleation), 3-4 (enucleoresection) and 5 (resection) were reported in 53.3%, 27.3% and 19.4% of cases, respectively. A PSM was recorded in 18 (6.2%) patients. PSM rate was 4.5%, 11.4% and 3.6% in case of enucleation, enucleoresection and resection, respectively. Patients with PSMs had tumors with a higher rate of contact with the urinary collecting system (55.6% vs. 27.3%; p < 0.001) and a longer median warm ischemia time (22 vs. 16 min; p = 0.02) compared with patients with negative surgical margins, while no differences emerged between the two groups in terms of other tumor features (i.e., pathological diameter, PADUA score). In multivariable analysis, only enucleoresection (SIB score 3-4) versus enucleation (SIB score 0-2) was found to be an independent predictor of PSM at final pathology (HR: 2.68; 95% CI: 1.25-7.63; p = 0.04), while resection (SIB score 5) was not. Conclusions: In our experience, enucleoresection led to a higher risk of PSMs as compared to enucleation. Further studies are needed to assess the differential impacts of resection technique and surgeon's experience on margin status after robotic PN.
Filiaciones:
Di Maida, F:
Careggi Hosp, Dept Expt & Clin Med, Unit Oncol Minimally Invas Urol & Androl, I-50134 Florence, Italy
Campi, R:
Univ Florence, Careggi Hosp, Dept Expt & Clin Med, Unit Urol Robot Surg & Renal Transplantat, I-50134 Florence, Italy
Lane, BR:
Spectrum Hlth Med Grp, Dept Urol, Grand Rapids, MI 49508 USA
De Cobelli, O:
Univ Milan, European Inst Oncol IEO, Dept Urol, I-20141 Milan, Italy
Sanguedolce, F:
Southmead Hosp, Bristol Urol Inst, Bristol BS10 5NB, Avon, England
Fundacio Puigvert, Urooncol Unit, Barcelona 08025, Spain
Hatzichristodoulou, G:
Tech Univ Munich, Rechts Isar Univ Hosp, Dept Urol, D-81675 Munich, Germany
Martha Maria Hosp Nuremberg, Dept Urol, D-90491 Nurnberg, Germany
Antonelli, A:
Univ Brescia, Dept Urol, I-25121 Brescia, Italy
Univ Verona, Azienda Osped Univ Integrata Verona, Dept Urol, I-37126 Verona, Italy
Grosso, AA:
Careggi Hosp, Dept Expt & Clin Med, Unit Oncol Minimally Invas Urol & Androl, I-50134 Florence, Italy
Noyes, S:
Spectrum Hlth Med Grp, Dept Urol, Grand Rapids, MI 49508 USA
Rodriguez-Faba, O:
Fundacio Puigvert, Urooncol Unit, Barcelona 08025, Spain
Keeley, FX:
Southmead Hosp, Bristol Urol Inst, Bristol BS10 5NB, Avon, England
Langenhuijsen, J:
Radboud Univ Nijmegen, Dept Urol, Med Ctr, NL-6525 GA Nijmegen, Netherlands
Musi, G:
Univ Milan, European Inst Oncol IEO, Dept Urol, I-20141 Milan, Italy
Klatte, T:
Royal Bournemouth Hosp, Dept Urol, Bournemouth BH7 7DW, Dorset, England
Med Univ Vienna, Dept Urol, A-1090 Vienna, Austria
Roscigno, M:
ASST Papa Giovanni XXIII, Dept Urol, I-24127 Bergamo, Italy
Akdogan, B:
Hacettepe Univ, Sch Med, Dept Urol, TR-06800 Ankara, Turkey
Furlan, M:
Univ Brescia, Dept Urol, I-25121 Brescia, Italy
Simeone, C:
Univ Brescia, Dept Urol, I-25121 Brescia, Italy
Karakoyunlu, N:
Diskapi Yildirim Beyazit Training & Res Hosp, Dept Urol, TR-06145 Ankara, Turkey
Marszalek, M:
Sozialmed Zentrum Ost Donauspital, Dept Urol & Androl, A-1220 Vienna, Austria
Graz Med Univ, Dept Urol, A-8036 Graz, Austria
Capitanio, U:
IRCCS Osped San Raffaele, Div Expt Oncol, Unit Urol, Urol Res Inst URI, I-20132 Milan, Italy
Volpe, A:
Univ Piemonte Orientale, Maggiore Carita Hosp, Dept Urol, I-28100 Novara, Italy
Brookman-May, S:
Ludwig Maximilian Univ LMU, Dept Urol, Campus Grosshadern, D-80539 Munich, Germany
Janssen Pharma Res & Dev, San Diego, CA 92121 USA
Gschwend, JE:
Tech Univ Munich, Rechts Isar Univ Hosp, Dept Urol, D-81675 Munich, Germany
Smaldone, MC:
Fox Chase Canc Ctr, Div Urol Oncol, Philadelphia, PA 19111 USA
Uzzo, RG:
Fox Chase Canc Ctr, Div Urol Oncol, Philadelphia, PA 19111 USA
Kutikov, A:
Fox Chase Canc Ctr, Div Urol Oncol, Philadelphia, PA 19111 USA
Minervini, A:
Careggi Hosp, Dept Expt & Clin Med, Unit Oncol Minimally Invas Urol & Androl, I-50134 Florence, Italy
gold, Green Published
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