PD10-08 PROGNOSTIC IMPACT OF TUMOR SURROUNDING RENAL PARENCHYMA IN NEPHRON SPARING SURGERY – IS SIMPLE ENUCLEATION REALLY ENOUGH?
2014-03-28

You have accessJournal of UrologyKidney Cancer: Evaluation/Staging I1 Apr 2014PD10-08 PROGNOSTIC IMPACT OF TUMOR SURROUNDING RENAL PARENCHYMA IN NEPHRON SPARING SURGERY – IS SIMPLE ENUCLEATION REALLY ENOUGH? Stefan Aufderklamm, Jörg Hennenlotter, Tilman Todenhöfer, Nicolas Senghaas, Georgios Gakis, Marcus Scharpf, Arnulf Stenzl, and Christian Schwentner Stefan AufderklammStefan Aufderklamm More articles by this author , Jörg HennenlotterJörg Hennenlotter More articles by this author , Tilman TodenhöferTilman Todenhöfer More articles by this author , Nicolas SenghaasNicolas Senghaas More articles by this author , Georgios GakisGeorgios Gakis More articles by this author , Marcus ScharpfMarcus Scharpf More articles by this author , Arnulf StenzlArnulf Stenzl More articles by this author , and Christian SchwentnerChristian Schwentner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.484AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical nephrectomy for renal cell carcinoma (RCC) has been supplemented by partial nephrectomy leading to improvements in overall survival. Traditional partial nephrectomy techniques have always considered a significant safety margin to be mandatory. Recently there has been controversial reporting that simple enucleation of the mass with an intact capsule might be sufficient for oncological control. However, the question if a safety margin was needed and which extent it should have remains widely unanswered. Herein, we present the impact of the presence and the volume of a safety margin on the clinical course of RCC. METHODS The study comprised 126 patients (median age 63 years, 17 to 82). Of those 91 were males and 35 females. Tumor stages were: pT1 in 120, pT2 in 2 and pT3 in 4 patients. Grades were: G1 in 43, G2 in 72 and G3 in 1 patient. Partial nephrectomy was done between 2000 and 2009 (84 open and 40 laparoscopy). Patients with a positive margin were excluded from the analysis. The width of the respective safety margin of renal parenchyma adjacent to the tumor was assessed histopathologically and measured on multiple spots. Results were compared and correlated with the clinical outcome. RESULTS Median follow-up was 65,5 months (Range 1-116). In 84 patients a clear cell RCC was found, in 33 a papillary RCC and in 8 a chromophobe RCC. Nine of 126 patients had a local or distant recurrent disease (11,3 %). The mean histopathological safety margin was 2 mm. Of 46 patients with a safety margin >1mm only one patient had a RCC relapse. In contrast 8 of 66 patients with a benign margin of ≤ 1mm were recurrent. The univariate cox proportional hazard analysis showed that a safety margin of ≤ 1mm is associated with Tumor relapse (p=0.05). In a multivariate analysis adjusted for T-stage and grading we could show a correlation between a histological safety margin of ≤ 1mm and a significantly elevated risk for RCC relapse (p=0,0165). CONCLUSIONS Partial nephrectomy has been shown to be an effective alternative to radical nephrectomy in organ-confined RCC with improved overall survival. In this study we could show that a surgical margin of ≤ 1 mm correlates with an elevated risk for recurrence. Hence, simple enucleation cannot be deemed sufficiently safe. This fact corroborates the recommendations of traditional open partial nephrectomy. Based on our data we suggest a safety margin of at least 2 mm when nephron-sparing surgery is attempted for localized RCC. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e284 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Stefan Aufderklamm More articles by this author Jörg Hennenlotter More articles by this author Tilman Todenhöfer More articles by this author Nicolas Senghaas More articles by this author Georgios Gakis More articles by this author Marcus Scharpf More articles by this author Arnulf Stenzl More articles by this author Christian Schwentner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...