Positive surgical margin’s impact on short-term oncological prognosis after robot-assisted partial nephrectomy (MARGINS study: UroCCR no 96)
A. Morrone, Imad Bentellis, Jean‐Christophe Bernhard, Karim Bensalah, C. Champy, F. Bruyère, N. Doumerc, Jonathan Olivier, François Audenet, Bastien Parier, Martin Brenier, Jean‐Alexandre Long, François‐Xavier Nouhaud, Nicolas Branger, Hervé Lang, T. Charles, Évanguelos Xylinas, Thibaut Waeckel, Florie Gomez, R. Boissier, Benjamin Rouget, Aysha Shaikh, D. Chevallier, Damien Ambrosetti, M. Durand
Abstract
The oncological impact of positive surgical margins (PSM) after robot-assisted partial nephrectomy (RAPN) is still under debate. We compared PSM and Negative Surgical Margins (NSM) in terms of recurrence-free survival (RFS), metastasis-free survival (MFS) and overall survival (OS) after RAPN, and we identified predictive factors of PSM. Multi-institutional study using the UroCCR database, which prospectively included 2166 RAPN between April 2010 and February 2021 (CNIL DR 2013-206; NCT03293563). Two groups were retrospectively compared: PSM versus NSM. Prognostic factors were assessed using Kaplan-Meyer curves with log-Rank test, cox hazard proportional risk model and logistic regression after univariate comparison. 136 patients had PSM (6.3%) and 2030 (93.7%) had NSM. During a median follow-up of 19 (9-36) months after RAPN, 160 (7.4%) recurrences were reported. Kaplan-Meier curves and analysis suggested that RFS, MFS and OS were not affected by a PSM (p = 0.68; 0.71; 0.88, respectively). In multivariate analysis predictors of PSM were a lower RENAL score (p = 0.001), longer warm ischemia time (WIT) (p = 0.003) and Chromophobe Renal Cell Carcinoma (chrRCC) (p = 0.043). This study found no impact of PSM on RFS, MFS or OS, and predictors of PSM were the RENAL score, WIT and chrRCC.