CODE: 9.3 - Influence of surgical margin width on selected morphological and clinical factors and long term results of nephron sparing surgery in patients with neoplasmatic kidney tumor
Article published in Urologia Polska 2006/59/Suplement 1.
Andrzej Kupilas, Mieczysław Fryczkowski, Andrzej Paradysz
- Katedra i Klinika Urologii w Zabrzu ¦l±skiej Akademii Medycznej w Katowicach
- Introduction. During many years of conducting nephron sparing surgery there is no agreement according to optimal margin width, which would allow to keep maximum renal parenchyma and oncologic radicality simultaneously.
- The aim of the study. Valuation of influence of surgical margin width on selected morphological and clinical factors and long term results of nephron sparing surgery in patients with neoplasmatic kidney tumor.
- Material and method. Charts of 169 patients who underwent nephron sparing surgery in Urology Clinic and Department in Zabrze between 1.09.1976 and 10.10.2005 were retrospectively analyzed. Influence of histopathological grade, clinical stage (TNM), tumor size, morphologic type and localization in dependence of margin width on long term results was evaluated. Patients were devided into 2 groups: I group - margin width over 5 mm - resections, II group - margin width under 5 mm - excavations. Follow-up was according to EORTC guidelines.
- Results. In I group we observed lower percentage of positive margins, however there was no significant difference with respect to recurrence rate, general and tumor-specific survival and death rate. Recurrence rate, death ratio and survival time were significantly lower in patients who underwent surgery because of imperative indications. Operations with ischemia were conducted more frequently in I group. Mean observation period in I group was 47.6 (3-204) months vs 73.5 (2-195) in II group.
- Conclusions. 1. Margin width has no statistically significant influence on death rate and general and tumor-specific survival in patients with pT1a stage renal tumors. 2. Margin width influence positive margin percentage however it does not influence local recurrence rate and metastases. 3. Imperative indications for NSS statistically significantly deteriorate results and prognosis after surgery. 4. Histopathological grade (G2-G3) significantly deteriorates prognosis in patients after NSS.