Current strategies to diagnose and manage positive surgical margins and local recurrence after partial nephrectomy

doi:10.1016/j.ajur.2022.06.002

Asian Journal of Urology, 2022, 9 (3): 227-242 doi: 10.1016/j.ajur.2022.06.002

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Current strategies to diagnose and manage positive surgical margins and local recurrence after partial nephrectomy

Umberto Carbonara^a,b,*(

),Daniele Amparore^a,c,Cosimo Gentile^b,Riccardo Bertolo^a,d,Selcuk Erdem^a,e,Alexandre Ingels^a,f,Michele Marchioni^a,g,Constantijn H.J. Muselaers^a,h,Onder Kara^a,i,Laura Marandino^a,j,Nicola Pavan^a,k,Eduard Roussel^a,l,Angela Pecoraro^a,c,Fabio Crocerossa^m,Giuseppe Torre^b,Riccardo Campi^a,n,Pasquale Ditonno^b

^aEuropean Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group
^bDepartment of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
^cDivision of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
^dDepartment of Urology, San Carlo Di Nancy Hospital, Rome, Italy
^eDivision of Urologic Oncology, Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
^fDepartment of Urology, University Hospital Henri Mondor, APHP, Créteil, France
^gDepartment of Urology, SS Annunziata Hospital, "G. D’Annunzio" University of Chieti, Chieti, Italy
^hDepartment of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
ⁱDepartment of Urology, Kocaeli University School of Medicine, Kocaeli, Turkey
^jDepartment of Medical Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
^kUrology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
^lDepartment of Urology, University Hospitals Leuven, Leuven, Belgium
^mDepartment of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
ⁿUnit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy

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Abstract

Objective: No standard strategy for diagnosis and management of positive surgical margin (PSM) and local recurrence after partial nephrectomy (PN) are reported in literature. This review aims to provide an overview of the current strategies and further perspectives on this patient setting.
Methods: A non-systematic review of the literature was completed. The research included the most updated articles (about the last 10 years).
Results: Techniques for diagnosing PSMs during PN include intraoperative frozen section, imprinting cytology, and other specific tools. No clear evidence is reported about these methods. Regarding PSM management, active surveillance with a combination of imaging and laboratory evaluation is the first option line followed by surgery. Regarding local recurrence management, surgery is the primary curative approach when possible but it may be technically difficult due to anatomy resultant from previous PN. In this scenario, thermal ablation (TA) may have the potential to circumvent these limitations representing a less invasive alternative. Salvage surgery represents a valid option; six studies analyzed the outcomes of nephrectomy on local recurrence after PN with three of these focused on robotic approach. Overall, complication rates of salvage surgery are higher compared to TA but ablation presents a higher recurrence rate up to 25% of cases that can often be managed with repeat ablation.
Conclusion: Controversy still exists surrounding the best strategy for management and diagnosis of patients with PSMs or local recurrence after PN. Active surveillance is likely to be the optimal first-line management option for most patients with PSMs. Ablation and salvage surgery both represent valid options in patients with local recurrence after PN. Conversely, salvage PN and radical nephrectomy have fewer recurrences but are associated with a higher complication rate compared to TA. In this scenario, robotic surgery plays an important role in improving salvage PN and radical nephrectomy outcomes.

Key words： Positive surgical margin Local recurrence Partial nephrectomy Radical nephrectomy Robot-assisted partial nephrectomy

Received: 04 January 2022 Available online: 20 July 2022

Corresponding Authors: Umberto Carbonara E-mail: u.carbonara@gmail.com

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	Umberto Carbonara
	Daniele Amparore
	Cosimo Gentile
	Riccardo Bertolo
	Selcuk Erdem
	Alexandre Ingels
	Michele Marchioni
	Constantijn H.J. Muselaers
	Onder Kara
	Laura Marandino
	Nicola Pavan
	Eduard Roussel
	Angela Pecoraro
	Fabio Crocerossa
	Giuseppe Torre
	Riccardo Campi
	Pasquale Ditonno

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Cite this article:

Umberto Carbonara,Daniele Amparore,Cosimo Gentile, et al. Current strategies to diagnose and manage positive surgical margins and local recurrence after partial nephrectomy[J]. Asian Journal of Urology, 2022, 9(3): 227-242.

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http://www.ajurology.com/EN/10.1016/j.ajur.2022.06.002 OR http://www.ajurology.com/EN/Y2022/V9/I3/227

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