Di Maida Fabrizio, Campi Riccardo, Lane Brian R, De Cobelli Ottavio, Sanguedolce Francesco, Hatzichristodoulou Georgios, Antonelli Alessandro, Grosso Antonio Andrea, Noyes Sabrina, Rodriguez-Faba Oscar, Keeley Frank X, Langenhuijsen Johan, Musi Gennaro, Klatte Tobias, Roscigno Marco, Akdogan Bulent, Furlan Maria, Simeone Claudio, Karakoyunlu Nihat, Marszalek Martin, Capitanio Umberto, Volpe Alessandro, Brookman-May Sabine, Gschwend Jürgen E, Smaldone Marc C, Uzzo Robert G, Kutikov Alexander, Minervini Andrea
Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, 50134 Florence, Italy.
Unit of Urological Robotic Surgery and Renal Transplantation, Department of Experimental and Clinical Medicine, University of Florence, Careggi Hospital, 50134 Florence, Italy.
J Clin Med. 2022 Mar 23;11(7):1765. doi: 10.3390/jcm11071765.
Background: To explore predictors of positive surgical margins (PSM) after robotic partial nephrectomy (PN) in a large multicenter international observational project, harnessing the Surface-Intermediate-Base (SIB) margin score to report the resection technique after PN in a standardized way. Methods: Data from consecutive patients with cT1-2N0M0 renal masses treated with PN from September 2014 to March 2015 at 16 tertiary referral centers and included in the SIB margin score International Consortium were prospectively collected. For the present study, only patients treated with robotic PN were included. Uni- and multivariable analysis were fitted to explore clinical and surgical predictors of PSMs after PN. Results: Overall, 289 patients were enrolled. Median (IQR) preoperative tumor size was 3.0 (2.3−4.2) cm and median (IQR) PADUA score was 8 (7−9). SIB scores of 0−2 (enucleation), 3−4 (enucleoresection) and 5 (resection) were reported in 53.3%, 27.3% and 19.4% of cases, respectively. A PSM was recorded in 18 (6.2%) patients. PSM rate was 4.5%, 11.4% and 3.6% in case of enucleation, enucleoresection and resection, respectively. Patients with PSMs had tumors with a higher rate of contact with the urinary collecting system (55.6% vs. 27.3%; p < 0.001) and a longer median warm ischemia time (22 vs. 16 min; p = 0.02) compared with patients with negative surgical margins, while no differences emerged between the two groups in terms of other tumor features (i.e., pathological diameter, PADUA score). In multivariable analysis, only enucleoresection (SIB score 3−4) versus enucleation (SIB score 0−2) was found to be an independent predictor of PSM at final pathology (HR: 2.68; 95% CI: 1.25−7.63; p = 0.04), while resection (SIB score 5) was not. Conclusions: In our experience, enucleoresection led to a higher risk of PSMs as compared to enucleation. Further studies are needed to assess the differential impacts of resection technique and surgeon’s experience on margin status after robotic PN.
在一个大型多中心国际观察项目中，探讨机器人辅助部分肾切除术（PN）后手术切缘阳性（PSM）的预测因素，利用表面-中间-基底（SIB）切缘评分以标准化方式报告PN后的切除技术。方法：前瞻性收集2014年9月至2015年3月在16个三级转诊中心接受PN治疗的连续cT1-2N0M0肾肿块患者的数据，这些患者被纳入SIB切缘评分国际联盟。本研究仅纳入接受机器人辅助PN治疗的患者。进行单变量和多变量分析以探讨PN后PSM的临床和手术预测因素。结果：总体而言，共纳入289例患者。术前肿瘤大小的中位数（IQR）为3.0（2.3−4.2）cm，PADUA评分的中位数（IQR）为8（7−9）。SIB评分为0−2（剜除术）、3−4（剜除切除术）和5（切除术）的病例分别占53.3%、27.3%和19.4%。18例（6.2%）患者记录有PSM。剜除术、剜除切除术和切除术的PSM率分别为4.5%、11.4%和3.6%。与手术切缘阴性的患者相比，有PSM的患者肿瘤与集合系统接触的比例更高（55.6%对27.3%；p<0.001），中位热缺血时间更长（分别为22分钟和16分钟；p = 0.02），而两组在其他肿瘤特征（即病理直径、PADUA评分）方面无差异。在多变量分析中，仅发现剜除切除术（SIB评分3−4）与剜除术（SIB评分0−2）相比是最终病理中PSM的独立预测因素（HR：2.68；95%CI：1.25−7.63；p = 0.04），而切除术（SIB评分5）不是。结论：根据我们的经验，与剜除术相比，剜除切除术导致PSM的风险更高。需要进一步研究以评估切除技术和外科医生经验对机器人辅助PN后切缘状态的不同影响。
