Year: 2006
Type: article
Abstract: INTRODUCTION AND OBJECTIVE:The oncologic efficacy of LPN largely depends on obtaining a negative surgical margin intraoperatively.This study assesses the oncologic outcomes of patients undergoing laparoscopic partial nephrectomy (LPN) for renal tumors who were noted to have a positive surgical margin on final pathology.METHODS: At 2 centers, a total of 511 patients with a pathologic diagnosis of renal cell carcinoma were treated with LPN.Patients with positive surgical margins were identified and medical records were reviewed retrospectively.The oncologic outcomes were assessed by follow-up for each patient included contrast enhanced -CT or MRI and serum creatinine every 6 months for 5 years after the procedure.RESULTS: Nine patients (1.8%) had positive margins on final pathology.Of these patients, none had serious postoperative complications or port site seeding.Mean tumor size was 2.8 em (range 1. 7 -4.0).Fuhrman grade was 2 in 7 patients and 3 in 2. Two individuals underwent radical nephrectomy, one at 4 days and one at 2 months following LPN.In both of these patients no residual tumor was identified in the specimen.Of the 7 patients on surveillance, 1 with a history of von Hipple-Lindau disease died of pancreatic metastasis within 10 months after LPN.Overall, 88% of the patients have remained disease free with a median follow-up of 32 months (6-76 months).CONCLUSIONS: Pathologic documentation of a focal positive margin does not necessarily indicate residual disease.Our mid-term follow-up indicates that recurrence parallels results seen in patients without positive parenchymal margin.Cause of this may be a false positive margin created by tissue deformation during extraction of the entrapped specimen through the small port-site.Further follow-up is necessary to determine long-term oncological outcomes in this group of patients.
Source: The Journal of Urology
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4250219338