Does a Positive Surgical Margin After Nephron Sparing Surgery Affect Oncological Outcome in Renal Cell Carcinoma? A Systematic Review and Meta-analysis

Nizar Hakam; Nassib Abou Heidar; Joanne Khabsa; Layal Hneiny; Elie A Akl; Raja Khauli

doi:10.1016/j.urology.2021.04.058

Does a Positive Surgical Margin After Nephron Sparing Surgery Affect Oncological Outcome in Renal Cell Carcinoma? A Systematic Review and Meta-analysis

Urology. 2021 Oct:156:e30-e39. doi: 10.1016/j.urology.2021.04.058. Epub 2021 Jun 27.

Authors

Nizar Hakam¹, Nassib Abou Heidar², Joanne Khabsa³, Layal Hneiny⁴, Elie A Akl⁵, Raja Khauli⁶

Affiliations

¹ Division of Urology and Renal Transplantation, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon; The Breyer Lab, University of California San Francisco, San Francisco, CA.
² Division of Urology and Renal Transplantation, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
³ Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon.
⁴ Saab Medical Library, University Libraries, American University of Beirut, Beirut, Lebanon.
⁵ Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon; Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
⁶ Division of Urology and Renal Transplantation, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: rkhauli@aub.edu.lb.

PMID: 34186133
DOI: 10.1016/j.urology.2021.04.058

Abstract

We systematically evaluated the impact of positive surgical margins (PSM) on oncological outcomes after partial nephrectomy for renal cell carcinoma. Forty-two studies comprising 101,153 subjects were included and five distinct meta-analyses were performed. PSM was associated with increased risk of local recurrence (hazard ratio (HR) 6.11-high certainty), metastasis (HR 3.29-moderate certainty), overall relapse (HR 2.25-high certainty), overall mortality (HR 1.30-moderate certainty), and may be associated with increased cancer-specific mortality (HR 1.91-low certainty). Patients with PSM should be counseled for the possibility of additional surgery, novel adjuvant therapies, and more rigorous surveillance.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Carcinoma, Renal Cell / surgery*
Humans
Kidney Neoplasms / surgery*
Margins of Excision*
Nephrectomy / methods*
Nephrons*
Organ Sparing Treatments / methods*
Treatment Outcome