Optimal Surgical Margin in Nephron-sparing Surgery for T1b Renal Cell Carcinoma

Objective To determine the optimal surgical margins in nephron-sparing surgery (NSS) for T1b renal cell carcinomas (RCC). Materials and Methods We retrospectively assessed 87 T1b RCC specimens after radical nephrectomy through whole-kidney continuous sections, with 92 T1a RCCs included as controls....

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Published in:Urology (Ridgewood, N.J.) N.J.), 2012-04, Vol.79 (4), p.836-839
Main Authors: Chen, Xu-sheng, Zhang, Zhen-ting, Du, Jun, Bi, Xin-chun, Sun, Guang, Yao, Xin
Format: Article
Language:English
Subjects:
Aged
Biological and medical sciences
Carcinoma, Renal Cell - pathology
Carcinoma, Renal Cell - surgery
Female
Humans
Kidney Neoplasms - pathology
Kidney Neoplasms - surgery
Kidneys
Male
Medical sciences
Middle Aged
Nephrectomy - methods
Nephrology. Urinary tract diseases
Retrospective Studies
Tumors of the urinary system
Urology
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Summary:Objective To determine the optimal surgical margins in nephron-sparing surgery (NSS) for T1b renal cell carcinomas (RCC). Materials and Methods We retrospectively assessed 87 T1b RCC specimens after radical nephrectomy through whole-kidney continuous sections, with 92 T1a RCCs included as controls. The completeness of pseudocapsule (PS) and extra-PS lesions and multifocality were microscopically examined, as was the greatest distance between extra-PS lesions and primary tumors. Results The rates of incomplete PS (34% [30/87] vs 18% [17/92], P = .015) and positive cancer lesions beyond the PS (39% [34/87] vs 25% [23/92], P = .043) were significantly higher in the T1b than in the T1a group. All extra-PS lesions were located within 3.0 mm of the primary tumor. Multifocal tumors were found in 6% (5/87) of patients with T1b and 5% (5/92) of patients with T1a tumors ( P = .928). Conclusion These results indicate that 4 mm may be the optimal surgical margin for NSS for patients with T1b RCC because all extra-PS lesions were located within 3 mm of the primary tumors.
ISSN:0090-4295
1527-9995
DOI:10.1016/j.urology.2011.11.023