William Tabayoyong1, Robert Abouassaly2, Jonathan E Kiechle1, Edward E Cherullo3, Neal J Meropol4, Nilay D Shah5, Shan Dong1, R Houston Thompson6, Marc C Smaldone7, Hui Zhu8, Sarah Ialacci3, Simon P Kim9. 1. Urology Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio. 2. Urology Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio; Center for Health Care Quality and Outcomes, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio; Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio. 3. Urology Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio; Center for Health Care Quality and Outcomes, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio. 4. Division of Hematology and Oncology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio; Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio. 5. Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota. 6. Department of Urology, Mayo Clinic, Rochester, Minnesota. 7. Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania. 8. Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio; Department of Urology, Cleveland Clinic, Cleveland, Ohio. 9. Urology Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio; Center for Health Care Quality and Outcomes, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio; Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio; Department of Internal Medicine, Cancer Outcomes and Public Policy Effectiveness Research Center, Yale University, New Haven, Connecticut. Electronic address: simkim@me.com.
Abstract
PURPOSE: We assessed the relationship of surgical margins across different surgical approaches to partial nephrectomy in patients with clinical T1a renal cell carcinoma in a population based cohort. MATERIALS AND METHODS: We used NCDB (National Cancer Database) to identify all patients who underwent partial nephrectomy for clinical T1a renal cell carcinoma (tumor size less than 4 cm) from 2010 to 2011. The primary outcome was surgical margin status in patients treated with partial nephrectomy by the open, laparoscopic or robotic approach. Multivariable logistic regression analysis was done to identify patient, hospital and surgical factors associated with positive surgical margins. RESULTS: Partial nephrectomy was done in 11,587 patients, including open, laparoscopic and robotic nephrectomy in 5,094 (44%), 1,681 (14%) and 4,812 (42%), respectively. Mean±SD age was 56±12 years. Overall 806 patients (7%) had positive surgical margins. The positive surgical margin prevalence was 4.9%, 8.1% and 8.7% for the open, laparoscopic and robotic approaches, respectively (p<0.001). Laparoscopic and robotic partial nephrectomy had a higher adjusted OR for positive surgical margins (OR 1.81 and 1.79, respectively, each p<0.001) than open nephrectomy. When stratified by hospital type, differences in positive surgical margin rates remained, such that patients treated at academic medical centers who underwent laparoscopic and robotic partial nephrectomy had a higher adjusted OR (1.38, p=0.074 and 1.73, p<0.001, respectively) than patients treated with open partial nephrectomy. CONCLUSIONS: Laparoscopic and robotic partial nephrectomy is associated with higher positive surgical margin rates compared to open partial nephrectomy for clinical T1a renal cell carcinoma. The effect of margin status on long-term oncologic outcomes in this context remains to be determined.
PURPOSE: We assessed the relationship of surgical margins across different surgical approaches to partial nephrectomy in patients with clinical T1a renal cell carcinoma in a population based cohort. MATERIALS AND METHODS: We used NCDB (National Cancer Database) to identify all patients who underwent partial nephrectomy for clinical T1a renal cell carcinoma (tumor size less than 4 cm) from 2010 to 2011. The primary outcome was surgical margin status in patients treated with partial nephrectomy by the open, laparoscopic or robotic approach. Multivariable logistic regression analysis was done to identify patient, hospital and surgical factors associated with positive surgical margins. RESULTS: Partial nephrectomy was done in 11,587 patients, including open, laparoscopic and robotic nephrectomy in 5,094 (44%), 1,681 (14%) and 4,812 (42%), respectively. Mean±SD age was 56±12 years. Overall 806 patients (7%) had positive surgical margins. The positive surgical margin prevalence was 4.9%, 8.1% and 8.7% for the open, laparoscopic and robotic approaches, respectively (p<0.001). Laparoscopic and robotic partial nephrectomy had a higher adjusted OR for positive surgical margins (OR 1.81 and 1.79, respectively, each p<0.001) than open nephrectomy. When stratified by hospital type, differences in positive surgical margin rates remained, such that patients treated at academic medical centers who underwent laparoscopic and robotic partial nephrectomy had a higher adjusted OR (1.38, p=0.074 and 1.73, p<0.001, respectively) than patients treated with open partial nephrectomy. CONCLUSIONS: Laparoscopic and robotic partial nephrectomy is associated with higher positive surgical margin rates compared to open partial nephrectomy for clinical T1a renal cell carcinoma. The effect of margin status on long-term oncologic outcomes in this context remains to be determined.
Authors: Abimbola Ayangbesan; David M Golombos; Ron Golan; Padraic O'Malley; Patrick Lewicki; Xian Wu; Douglas S Scherr Journal: J Endourol Date: 2019-01 Impact factor: 2.942
Authors: Hugo Otaola-Arca; Alfred Krebs; Hugo Bermúdez; Raúl Lyng; Marcelo Orvieto; Alberto Bustamante; Conrado Stein; Andrés Labra; Marcela Schultz; Mario I Fernández Journal: Ann Surg Oncol Date: 2022-01-06 Impact factor: 5.344
Authors: Ercan Malkoç; Matthew J Maurice; Önder Kara; Daniel Ramirez; Ryan J Nelson; Julien Dagenais; Khaled Fareed; Amr Fergany; Robert J Stein; Pascal Mouracade; Jihad H Kaouk Journal: Turk J Urol Date: 2019-01-01