Surgical Margins in Nephron-Sparing Surgery for Renal Cell Carcinoma

Abstract

The oncologic impact of positive surgical margins after nephron-sparing surgery is controversial. Herein, we discuss current data surrounding surgical margins in the operative management of renal cell carcinoma. The prevalence, risk factors, outcomes, and subsequent management of positive surgical margins will be reviewed. Literature suggests that the prevalence of positive surgical margins following kidney surgery varies by practice setting, tumor characteristics, and operation type. For patients undergoing nephron-sparing surgery, it is not necessary to remove a margin of healthy tissue. Tumor enucleation may be appropriate and is associated with comparable outcomes. Reflexive intraoperative frozen section use does not provide beneficial information and many patients with positive margins can be monitored closely with serial imaging. The impact of positive surgical margins on recurrence and survival remains conflicting. Though every effort must be performed to obtain negative margins, a positive surgical margin appears to have a marginal impact on recurrence and survival.

Keywords: Nephron-sparing surgery; Partial nephrectomy; Positive surgical margins; Renal cell carcinoma; Renal tumor; Tumor enucleation.