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Variation in Surgical Margin Status by Surgical Approach among Patients Undergoing Partial Nephrectomy for Small Renal Masses

2015; Lippincott Williams & Wilkins; Volume: 194; Issue: 6 Linguagem: Inglês

10.1016/j.juro.2015.06.076

1527-3792

William Tabayoyong, Robert Abouassaly, Jonathan Kiechle, Edward E. Cherullo, Neal J. Meropol, Nilay D. Shah, Shan Dong, R. Houston Thompson, Marc C. Smaldone, Hui Zhu, Sarah Ialacci, Simon P. Kim,

Renal and Vascular Pathologies

No AccessJournal of UrologyAdult Urology1 Dec 2015Variation in Surgical Margin Status by Surgical Approach among Patients Undergoing Partial Nephrectomy for Small Renal Masses William Tabayoyong, Robert Abouassaly, Jonathan E. Kiechle, Edward E. Cherullo, Neal J. Meropol, Nilay D. Shah, Shan Dong, R. Houston Thompson, Marc C. Smaldone, Hui Zhu, Sarah Ialacci, and Simon P. Kim William TabayoyongWilliam Tabayoyong Urology Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio , Robert AbouassalyRobert Abouassaly 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 , Jonathan E. KiechleJonathan E. Kiechle Urology Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio , Edward E. CherulloEdward E. Cherullo 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 , Neal J. MeropolNeal J. Meropol 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 , Nilay D. ShahNilay D. Shah Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota , Shan DongShan Dong Urology Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio , R. Houston ThompsonR. Houston Thompson Department of Urology, Mayo Clinic, Rochester, Minnesota , Marc C. SmaldoneMarc C. Smaldone Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania , Hui ZhuHui Zhu Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio Department of Urology, Cleveland Clinic, Cleveland, Ohio , Sarah IalacciSarah Ialacci 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 , and Simon P. KimSimon P. Kim 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 View All Author Informationhttps://doi.org/10.1016/j.juro.2015.06.076AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail 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. References 1 : Cancer statistics, 2014. CA Cancer J Clin2014; 64: 9. Google Scholar 2 : Rising incidence of renal cell cancer in the United States. JAMA1999; 281: 1628. 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Link, Google Scholar © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byAbel E (2019) Editorial CommentJournal of Urology, VOL. 203, NO. 3, (503-503), Online publication date: 1-Mar-2020.Shah P, Alom M, Leibovich B, Thompson R, Uzzo R, Kavoussi L, Richstone L, Bhindi B, Habermann E, Joshi V and Boorjian S (2018) The Temporal Association of Robotic Surgical Diffusion with Overtreatment of the Small Renal MassJournal of Urology, VOL. 200, NO. 5, (981-988), Online publication date: 1-Nov-2018.Matulewicz R, Tosoian J, Stimson C, Ross A, Chappidi M, Lotan T, Humphreys E, Partin A and Schaeffer E (2016) Implementation of a Surgeon-Level Comparative Quality Performance Review to Improve Positive Surgical Margin Rates during Radical ProstatectomyJournal of Urology, VOL. 197, NO. 5, (1245-1250), Online publication date: 1-May-2017.Kim S and Abouassaly R (2016) Treatment of Patients with Positive Margins after Partial NephrectomyJournal of Urology, VOL. 196, NO. 2, (301-302), Online publication date: 1-Aug-2016. Volume 194Issue 6December 2015Page: 1548-1553Supplementary Materials Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.Keywordsrenal cellkidneycarcinomaoutcome and process assessment (health care)minimally invasive surgical proceduresnephrectomyMetricsAuthor Information William Tabayoyong Urology Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio More articles by this author Robert Abouassaly 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 More articles by this author Jonathan E. Kiechle Urology Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio More articles by this author Edward E. Cherullo 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 More articles by this author Neal J. Meropol 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 More articles by this author Nilay D. Shah Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota More articles by this author Shan Dong Urology Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio More articles by this author R. Houston Thompson Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author Marc C. Smaldone Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania More articles by this author Hui Zhu Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio Department of Urology, Cleveland Clinic, Cleveland, Ohio More articles by this author Sarah Ialacci 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 More articles by this author Simon P. Kim 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 More articles by this author Expand All Advertisement PDF downloadLoading ...