Introduction

The prognostic significance and optimal management of positive surgical margins following partial nephrectomy remain controversial. The association between positive margin and risk of disease recurrence in patients with clinically localized renal neoplasm undergoing partial nephrectomy was evaluated.

Methods

We analyzed the records of 429 patients cases of non-metastatic renal cell carcinoma who underwent partial nephrectomy (PN) at our institution, from 2001 to 2016. Recurrence-free survival was evaluated using Kaplan-Meier method, log rank test and Cox models adjusting for tumor size, grade, histology, pathological stage, focality and laterality. The relationship between positive margin and risk of relapse was evaluated independently for pathological high risk (Fuhrman grades III-IV) and low risk (Fuhrman grades I-II) groups.

Results

A positive surgical margin was found in 55 (12.8%) patients. Recurrence developed in 26 (6%) patients during a median follow-up of 39 months. A positive margin was associated with an increased risk of relapse on multivariable analysis (HR 3.34, CI95%: 1.24 - 8.10, p= 0.01) Graph 1. In a stratified analysis based on pathological features, a positive surgical margin was significantly associated with a higher risk of recurrence in cases of high risk (Fuhrmann III-IV) (HR 13.8, CI95%: 4.19 - 45.9, p= 0.0005) Graph 2.

Conclusions

Positive surgical margins after partial nephrectomy increase the risk of disease recurrence, primarily in patients with high-risk pathological features. _x000D_

Funding

none