1801 RISK FACTORS AND INTERMEDIATE TERM ONCOLOGIC OUTCOMES FOR POSITIVE MARGINS DURING ROBOTIC PARTIAL NEPHRECTOMY

Field: Medicine (Health Sciences)

You have accessJournal of UrologyKidney Cancer: Localized (V)1 Apr 20131801 RISK FACTORS AND INTERMEDIATE TERM ONCOLOGIC OUTCOMES FOR POSITIVE MARGINS DURING ROBOTIC PARTIAL NEPHRECTOMY Louis Krane, Ted Manny, Brandy Hood, and Ashok K. Hemal Louis KraneLouis Krane Winston-Salem, NC More articles by this author , Ted MannyTed Manny Winston-Salem, NC More articles by this author , Brandy HoodBrandy Hood Winston-Salem, NC More articles by this author , and Ashok K. HemalAshok K. Hemal Winston-Salem, NC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2851AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In patients undergoing robotic partial nephrectomy (RPN), the risk factors for positive surgical margin (PSM) and intermediate term oncologic follow-up for these patients have not been identified. The objective of this study is to identify which patients are at risk for PSM and the oncologic outcome in PSM patients. METHODS A prospectively maintained institutional review board approved database of patients undergoing RPN was queried for patients with PSM and these were compared to the remainder of the cohort. Patients with positive margins were followed with renal ultrasounds computerized tomography or magnetic resonance imaging at 3, 6 and 12 months and annually thereafter. RESULTS Of 253 consecutive patients undergoing RPN, 20 (7.9%) had a PSM on final histopathologic analysis. Demographics of this cohort are outlined in Table 1. At a mean follow up of 27 months (Range 6 - 56) no patients had experienced disease recurrence and overall survival remained 100%. Logistic regression analysis was performed to identify risk factors for PSM as compared to the entire cohort. Table 2 shows higher Nephrometry grouping had increased risk of PSM, and usage of indocyanine green dye trended to decrease in risk of margins. CONCLUSIONS Higher Nephrometry score purported increased risk of PSM at the time of RPN. Patients with PSM have excellent intermediate oncologic control, however they will require aggressive follow up with cross sectional imaging to ensure there is no disease recurrence. Table 1. Characteristics of Positive Surgical Margins in Robotic Partial Nephrectomy Mean or Total Number SD or % Size (cm) 2.8 0.99 Pathologic Stage pT1a 17 85% pT1b 2 10% pT3a 1 5% Histopathology Clear Cell 11 55% Chromophobe 5 25% Papillary 3 15% Cystic Clear Cell 1 5% Overall Followup (months) 27 14 Table 2. Logistic Regression Analysis of Risk Factors for Positive Margin during Robotic Partial Nephrectomy OR 95% CI p Value Age (per year) 1.01 .98 - 1.06 0.44 Body Mass Index (per kg/m2) 1.03 0.96 - 1.11 0.39 CT Tumor Size (per cm) 1.16 0.79 - 1.63 0.43 Nephrometry Group Low (4-6) 1 (ref) Moderate (7-9) 2.94 1.10 - 8.40 0.032 High (10+) 2.68 0.37 - 12.83 0.29 Usage of Indocyanine Green Dye 2.67 0.99 - 8.50 0.054 Clamping Technique None 1 (ref) Artery Only 3.28 0.58 - 61.9 0.20 Artery and Vein 2.72 0.47 - 51.6 0.30 Polarity Upper 1 (ref) Interpolar 1.39 0.44 - 4.53 0.57 Lower 0.72 0.23 - 2.26 0.57 Location Anterior 1 (ref) Lateral 1.09 0.23 - 4.02 0.90 Posterior 1.04 0.37 - 2.89 0.93 Experience (per case in series) 0.99 0.98 - 1.00 0.15 © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e740-e741 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Louis Krane Winston-Salem, NC More articles by this author Ted Manny Winston-Salem, NC More articles by this author Brandy Hood Winston-Salem, NC More articles by this author Ashok K. Hemal Winston-Salem, NC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...