Positive surgical margins and local recurrence after simple enucleation and standard partial nephrectomy for malignant renal tumors: Systematic review of the literature and meta-analysis of prevalence

Andrea Minervini, Riccardo Campi, Francesco Sessa, Ithaar Derweesh, Jihad H. Kaouk, Andrea Mari, Koon H. Rha, Maurizio Sessa, Alessandro Volpe, Marco Carini, Robert G. Uzzo

Research output: Contribution to journalReview article

27 Citations (Scopus)

Abstract

INTRODUCTION: The definition of the safest width of healthy renal margin to achieve oncological efficacy and therefore of the safest resection technique (RT) during partial nephrectomy (PN) continues to be widely debated. The aim of this study is to evaluate the prevalence of positive surgical margins (PSM), loco-regional recurrence (LRR) and renal recurrence (RER) rates after simple enucleation (SE) and standard partial nephrectomy (SPN) for malignant renal tumors. EVIDENCE ACQUISITION: A systematic review of the English-language literature was performed through August 2016 using the Medline, Web of Science and Embase databases according to the PRISMA criteria. A systematic review and meta-analysis was performed in those studies that defined the exact anatomical location of recurrence after PN. EVIDENCE SYNTHESIS: Overall, 33 studies involving 11,282 patients were selected for quantitative analysis. At a median follow-up of 43 (SE) and 52 (SPN) months, the pooled estimates of the prevalence of PSMs, LRR and RER were 2.7% (95% CI: 1.5-4.6%, P<0.001) and 0.4% (95% CI: 0.1-2.2%, P=0.018), 2.0% (95% CI: 1.4-2.8%, P<0.001) and 0.9% (95% CI: 0.5-1,7%, P=0.04), 1.5% (95% CI: 0.9-2.3%, P=0.001) and 0.9% (95% CI: 0.5-1,7%, P=0.40) in patients undergoing SPN and SE, respectively. CONCLUSIONS: Our systematic analysis and meta-analysis demonstrates that SE is noninferior to SPN regarding PSM, LRR and RER rates in patients undergoing PN for malignant renal tumors. Further studies using standardized reporting tools are needed to evaluate the role of resection techniques for oncologic outcomes after PN.

Original languageEnglish
Pages (from-to)523-538
Number of pages16
JournalMinerva Urologica e Nefrologica
Volume69
Issue number6
DOIs
Publication statusPublished - 2017 Dec

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Nephrectomy
Meta-Analysis
Kidney
Recurrence
Neoplasms
Margins of Excision
Language
Databases

All Science Journal Classification (ASJC) codes

  • Nephrology
  • Urology

Cite this

Minervini, Andrea ; Campi, Riccardo ; Sessa, Francesco ; Derweesh, Ithaar ; Kaouk, Jihad H. ; Mari, Andrea ; Rha, Koon H. ; Sessa, Maurizio ; Volpe, Alessandro ; Carini, Marco ; Uzzo, Robert G. / Positive surgical margins and local recurrence after simple enucleation and standard partial nephrectomy for malignant renal tumors : Systematic review of the literature and meta-analysis of prevalence. In: Minerva Urologica e Nefrologica. 2017 ; Vol. 69, No. 6. pp. 523-538.
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title = "Positive surgical margins and local recurrence after simple enucleation and standard partial nephrectomy for malignant renal tumors: Systematic review of the literature and meta-analysis of prevalence",
abstract = "INTRODUCTION: The definition of the safest width of healthy renal margin to achieve oncological efficacy and therefore of the safest resection technique (RT) during partial nephrectomy (PN) continues to be widely debated. The aim of this study is to evaluate the prevalence of positive surgical margins (PSM), loco-regional recurrence (LRR) and renal recurrence (RER) rates after simple enucleation (SE) and standard partial nephrectomy (SPN) for malignant renal tumors. EVIDENCE ACQUISITION: A systematic review of the English-language literature was performed through August 2016 using the Medline, Web of Science and Embase databases according to the PRISMA criteria. A systematic review and meta-analysis was performed in those studies that defined the exact anatomical location of recurrence after PN. EVIDENCE SYNTHESIS: Overall, 33 studies involving 11,282 patients were selected for quantitative analysis. At a median follow-up of 43 (SE) and 52 (SPN) months, the pooled estimates of the prevalence of PSMs, LRR and RER were 2.7{\%} (95{\%} CI: 1.5-4.6{\%}, P<0.001) and 0.4{\%} (95{\%} CI: 0.1-2.2{\%}, P=0.018), 2.0{\%} (95{\%} CI: 1.4-2.8{\%}, P<0.001) and 0.9{\%} (95{\%} CI: 0.5-1,7{\%}, P=0.04), 1.5{\%} (95{\%} CI: 0.9-2.3{\%}, P=0.001) and 0.9{\%} (95{\%} CI: 0.5-1,7{\%}, P=0.40) in patients undergoing SPN and SE, respectively. CONCLUSIONS: Our systematic analysis and meta-analysis demonstrates that SE is noninferior to SPN regarding PSM, LRR and RER rates in patients undergoing PN for malignant renal tumors. Further studies using standardized reporting tools are needed to evaluate the role of resection techniques for oncologic outcomes after PN.",
author = "Andrea Minervini and Riccardo Campi and Francesco Sessa and Ithaar Derweesh and Kaouk, {Jihad H.} and Andrea Mari and Rha, {Koon H.} and Maurizio Sessa and Alessandro Volpe and Marco Carini and Uzzo, {Robert G.}",
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Positive surgical margins and local recurrence after simple enucleation and standard partial nephrectomy for malignant renal tumors : Systematic review of the literature and meta-analysis of prevalence. / Minervini, Andrea; Campi, Riccardo; Sessa, Francesco; Derweesh, Ithaar; Kaouk, Jihad H.; Mari, Andrea; Rha, Koon H.; Sessa, Maurizio; Volpe, Alessandro; Carini, Marco; Uzzo, Robert G.

In: Minerva Urologica e Nefrologica, Vol. 69, No. 6, 12.2017, p. 523-538.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Positive surgical margins and local recurrence after simple enucleation and standard partial nephrectomy for malignant renal tumors

T2 - Systematic review of the literature and meta-analysis of prevalence

AU - Minervini, Andrea

AU - Campi, Riccardo

AU - Sessa, Francesco

AU - Derweesh, Ithaar

AU - Kaouk, Jihad H.

AU - Mari, Andrea

AU - Rha, Koon H.

AU - Sessa, Maurizio

AU - Volpe, Alessandro

AU - Carini, Marco

AU - Uzzo, Robert G.

PY - 2017/12

Y1 - 2017/12

N2 - INTRODUCTION: The definition of the safest width of healthy renal margin to achieve oncological efficacy and therefore of the safest resection technique (RT) during partial nephrectomy (PN) continues to be widely debated. The aim of this study is to evaluate the prevalence of positive surgical margins (PSM), loco-regional recurrence (LRR) and renal recurrence (RER) rates after simple enucleation (SE) and standard partial nephrectomy (SPN) for malignant renal tumors. EVIDENCE ACQUISITION: A systematic review of the English-language literature was performed through August 2016 using the Medline, Web of Science and Embase databases according to the PRISMA criteria. A systematic review and meta-analysis was performed in those studies that defined the exact anatomical location of recurrence after PN. EVIDENCE SYNTHESIS: Overall, 33 studies involving 11,282 patients were selected for quantitative analysis. At a median follow-up of 43 (SE) and 52 (SPN) months, the pooled estimates of the prevalence of PSMs, LRR and RER were 2.7% (95% CI: 1.5-4.6%, P<0.001) and 0.4% (95% CI: 0.1-2.2%, P=0.018), 2.0% (95% CI: 1.4-2.8%, P<0.001) and 0.9% (95% CI: 0.5-1,7%, P=0.04), 1.5% (95% CI: 0.9-2.3%, P=0.001) and 0.9% (95% CI: 0.5-1,7%, P=0.40) in patients undergoing SPN and SE, respectively. CONCLUSIONS: Our systematic analysis and meta-analysis demonstrates that SE is noninferior to SPN regarding PSM, LRR and RER rates in patients undergoing PN for malignant renal tumors. Further studies using standardized reporting tools are needed to evaluate the role of resection techniques for oncologic outcomes after PN.

AB - INTRODUCTION: The definition of the safest width of healthy renal margin to achieve oncological efficacy and therefore of the safest resection technique (RT) during partial nephrectomy (PN) continues to be widely debated. The aim of this study is to evaluate the prevalence of positive surgical margins (PSM), loco-regional recurrence (LRR) and renal recurrence (RER) rates after simple enucleation (SE) and standard partial nephrectomy (SPN) for malignant renal tumors. EVIDENCE ACQUISITION: A systematic review of the English-language literature was performed through August 2016 using the Medline, Web of Science and Embase databases according to the PRISMA criteria. A systematic review and meta-analysis was performed in those studies that defined the exact anatomical location of recurrence after PN. EVIDENCE SYNTHESIS: Overall, 33 studies involving 11,282 patients were selected for quantitative analysis. At a median follow-up of 43 (SE) and 52 (SPN) months, the pooled estimates of the prevalence of PSMs, LRR and RER were 2.7% (95% CI: 1.5-4.6%, P<0.001) and 0.4% (95% CI: 0.1-2.2%, P=0.018), 2.0% (95% CI: 1.4-2.8%, P<0.001) and 0.9% (95% CI: 0.5-1,7%, P=0.04), 1.5% (95% CI: 0.9-2.3%, P=0.001) and 0.9% (95% CI: 0.5-1,7%, P=0.40) in patients undergoing SPN and SE, respectively. CONCLUSIONS: Our systematic analysis and meta-analysis demonstrates that SE is noninferior to SPN regarding PSM, LRR and RER rates in patients undergoing PN for malignant renal tumors. Further studies using standardized reporting tools are needed to evaluate the role of resection techniques for oncologic outcomes after PN.

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JO - Minerva Urologica e Nefrologica

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