Positive surgical margins in nephron-sparing surgery; the great unknown

Authors

Dan Spinu, Carol Davila University of Medicine and Farmacy, Central Military Emergency University Hospital, Department of UrologyFollow
Oana M. Bodean, Emergency University Hospital Bucharest, Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, RomaniaFollow
Bogdan Socea, Carol Davila University of Medicine and Pharmacy, Department of SurgeryFollow
Dan Mischianu, Carol Davila University of Medicine and Farmacy, Central Military Emergency University Hospital, Department of UrologyFollow
Ioana Oprea, Central Military Emergency University Hospital, Department of Intensive Care UnitFollow
Radu D. Marcu, Carol Davila University of Medicine and Farmacy, Central Military Emergency University Hospital, Department of UrologyFollow

Abstract

There is a currently a general trend towards organ-preserving surgery, and urology is no exception. Specifically, nephron-sparing surgery (NSS) has gained general acceptance for T1a renal cell carcinoma (guidelines recommendations). Moreover T1b, T2 and even T3 stage tumors have been included on the nephron sparing list at some centers. An unresolved issue is that of positive surgical margins (PSM), not only their detection but also the implications for follow up and treatment. This paper highlights data available on risk factors for PSM, their clinical relevance, and possible therapeutic consequences.

From the surgeon’s viewpoint, NSS is a daring and risky surgical procedure. Urological guidelines stress the importance of NSS, and thus the trend is moving in that direction. Unresolved, however, is the problem of PSM. Trifecta, MIC, and pentafecta are applicable concepts which attempt to define the optimal endpoint of NSS, but further elaboration is necessary. Specifically, research needs to focus less on the concept of definitive margins and more on their identification and avoidance. Although some studies suggest that PSMs do not influence overall survival rate, the basic idea of preserving tissue that is not cancerous leads to further medical, social, and psychological considerations.

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Recommended Citation

Spinu, Dan; Bodean, Oana M.; Socea, Bogdan; Mischianu, Dan; Oprea, Ioana; and Marcu, Radu D. (2018) "Positive surgical margins in nephron-sparing surgery; the great unknown," Journal of Mind and Medical Sciences: Vol. 5: Iss. 1, Article 5.
DOI: https://doi.org/10.22543/7674.51.P2128
Available at: https://scholar.valpo.edu/jmms/vol5/iss1/5