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Introduction
In patients undergoing partial nephrectomy for localized Renal Cell Carcinoma (RCC), positive surgical margin (PSM) is thought to increase risk for local recurrence. Our Objective is to describe the natural history of PSM following partial nephrectomy for RCC.
Methods
We identified 1044 patients who underwent partial nephrectomy at a single institution from 1988 to 2010. 45 patients had PSM (4.3%) confirmed by single pathologist review. Patients with familial kidney cancer, benign pathology, ≥pT2 disease, or follow up less than 6 months were excluded (n = 22). Clinical, pathological, and follow up data were analyzed for the remaining cohort (n = 23). RCC-specific survival and local recurrence were calculated.
Results
Mean age at diagnosis was 63 + 11 years. 82% of cases (19/23) were open while 4 were laparoscopic. 6 patients (26%) had a solitary kidney. 52% (12/23) of patients had vascular clamping. Mean tumor size was 3.2 + 1.3 cm, and 17/23 (74%) were pT1a. Surveillance imaging was performed every 6 months for two years, and yearly thereafter. Median follow up was 28 months.
No patient had elective invasive management of their PSM. Only 1/23 (4.3%) patient developed local recurrence 1.8 years after surgery. This was treated with systemic therapy as the patient had synchronous distant metastases. Among all patients with PSM, 3-year RCC-specific survival was 90%.
DISCUSSION
Local recurrence was rare among patients with PSM after partial nephrectomy for pT1 RCC at 28 months follow up. Post-operative surveillance is reasonable in patients with PSM after partial nephrectomy.