Does a Positive Surgical Margin After Nephron Sparing Surgery Affect Oncological Outcome in Renal Cell Carcinoma? A Systematic Review and Meta-analysis - 30/10/21

Doi : 10.1016/j.urology.2021.04.058

Nizar Hakam ^a,^b,^{^{#
Nizar Hakam and Nassib Abou Heidar contributed equally to the manuscript.}}, Nassib Abou Heidar ^a,^{^{#
Nizar Hakam and Nassib Abou Heidar contributed equally to the manuscript.}}, Joanne Khabsa ^c, Layal Hneiny ^d, Elie A. Akl ^c,^e, Raja Khauli ^a,^{^{1
Professor of Urology and Surgery, Director, Renal Transplantation Unit, American University of Beirut Medical Center, Department of Urology, Carle Foundation Hospital & Clinical Professor of Urology, Carle Illinois College of Medicine, Adjunct Professor of Urology, University of Massachusetts Medical Center, Director Middle East Prostate Cancer Consortium (MEPCC).},}^⁎
^a Division of Urology and Renal Transplantation, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
^b The Breyer Lab, University of California San Francisco, San Francisco, CA
^c Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
^d Saab Medical Library, University Libraries, American University of Beirut, Beirut, Lebanon
^e Department of Internal Medicine, American University of Beirut, Beirut, Lebanon

^⁎Address correspondence to: Raja Khauli, M.D., F.A.C.S, Division of Urology and Renal Transplantation, Department of Surgery, American University of Beirut Medical Center, P.O. Box 11-0236/ Riad Solh 1107 2020, Beirut, Lebanon.Division of Urology and Renal TransplantationDepartment of SurgeryAmerican University of Beirut Medical CenterP.O. Box 11-0236/ Riad Solh 1107 2020BeirutLebanon

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.

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Mots-clés : Abbreviations: CSM:, HR:, NOS:, NSM:, NSS:, PN:, PRISMA:, PSM:, RCC: