Effect of Positive Surgical Margin on Survival After Partial Nephrectomy for Renal Cell Cancer: Long-term Results of a Single Center

Abstract

Objective:The goal of this study is to evaluate the risk factors that cause positive surgical margin (PSM) after partial nephrectomy (PN) and the effect of PSM on oncological outcomes in a single-centre cohort.Materials and Methods:Patients with PSM (group 1) were identified and contrasted with the negative surgical margin (group 2). Further, the Kaplan-Meier curves and Cox regression models were used to estimate the differences in survival analysis.Results:A total of 302 patients had PN, of which 38 (12.6%) had PSM. In addition, the non-ischaemic procedures in group 1 were higher (p<0.001). Multivariate analysis showed that RENAL nephrometry score (OR: 1.438, p=0.037) and C-index value (OR: 0.224, p=0.012) were important predictive factors for PSM. Moreover, the recurrence rate was 7.9% for group 1 at a median follow-up of 85.2 months and 3.4% for group 2 at a median follow-up of 83.7 months (p=0.181). In a multivariate analysis, the overall survival decreased with co-morbidity index (HR: 1.343, p<0.001) and high tumour stage (HR: 3.886, p=0.003), while cancer-specific survival decreased with mid-renal tumours (HR: 4.157, p=0.007), high tumour stage (HR: 6.274, p=0.017) and recurrence (HR: 5.038, p=0.018). Furthermore, pathological T stage and C-index value were independent risk factors influencing recurrence-free survival.Conclusion:C-index and RENAL nephrometry score are independent risk factors for PSM. Additionally, PSM does not affect the recurrence or survival outcomes.

Keywords

• partial nephrectomy
• positive surgical margin
• survival