Resection technique predicts positive surgical margins after partial nephrectomy

Resection techniques appear to be significantly associated with surgical complications, early functional outcomes and positive surgical margins after partial nephrectomy of localized renal masses, suggests a recent study.

The authors sought to determine the pattern of resection techniques during partial nephrectomy and the impact on perioperative outcomes, acute kidney injury, positive surgical margins and Trifecta achievement (ie, negative surgical margins, no perioperative Clavien-Dindo grade ≥2 surgical complications and no postoperative acute kidney injury).

Data on consecutive patients with cT1-2N0M0 renal masses treated with partial nephrectomy at a total of 16 referral centres from September 2014 to March 2015 were prospectively collected. The surgeon then classified the resection technique after partial nephrectomy as enucleation, enucleoresection or resection based on the Surface-Intermediate-Base margin score 0–2, 3 or 4, and 5, respectively.

Multivariable logistic regression analysis was then performed to assess the potential impact of the resection technique on postoperative surgical complications, positive surgical margins, acute kidney injury and Trifecta achievement.

A total of 507 patients met the inclusion criteria. Resection techniques were classified as follows: enucleation in 266 patients (52 percent), enucleoresection in 150 (30 percent) and resection in 91 (18 percent).

The only significant predictor of positive surgical margins was the resection technique (enucleoresection vs enucleation and resection). Clavien-Dindo grade ≥2 surgical complications were significantly predicted by the following: tumour complexity, surgical approach (open and laparoscopic vs robotic) and resection technique (enucleoresection vs enucleation).

Furthermore, the surgical approach (open and laparoscopic vs robotic), the resection technique (enucleoresection vs enucleation) and warm ischaemia time significantly correlated with postoperative acute kidney injury and Trifecta achievement.