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Comparision of results of nephron-sparing surgery (NSS) with surgical margins to 3 mm versus over 5 mm width in patients with renal cell carcinoma (RCC)
Article published in Urologia Polska 2005/58/2.

authors

Mieczysław Fryczkowski, Andrzej Kupilas, Andrzej Paradysz, Andrzej Potyka, Marcin Życzkowski
Katedra i Klinika Urologii w Zabrzu Śląskiej Akademii Medycznej w Katowicach
Kierownik kliniki: prof. dr hab. Mieczysław Fryczkowski

keywords

kidney, kidney cancer, NSS, surgical margins, margin width

summary

introduction and objectives
The aim of the present study is to compare the results of nephron-sparing surgeries (NSS) with various surgical margins in patients with renal cell carcinoma (RCC).
material and methods
146 NSS operations were performed in 142 patients aged between 25-75 years (mean 58.2 years) from 01.1988 to 08.2004. Patients were divided into two groups. Group I and II consisted of 97 patients with surgical margin of less then 3 mm in length and 45 patients with surgical margin of more then 5 mm (mean 7.5 mm) in length respectively. Surgical margin and probes taken from surrounding kidney were histopathologically assessed. 11 clinical and morphological factors were statistically analyzed. Follow-up examinations were performed in accordance to EORTC indications from 06 to 204 months after NSS (mean 61.4 mths).
results
There was significantly more typical RCC, G1 and T1a tumors in Group I then in Group II. In comparison to Group I, there was more T1b, G2 tumors in Group II and the follow-up was shorter in Group II. Way of qualification to NSS influenced 5-year survival, progression and positive surgical margins rates.
conclusions
1. Progression rates, survival time and recurrence rate do not depend on surgical margins length.
2. Disease progression, survival time and length of surgical margins are influenced by indications for NSS.
3. Positive surgical margines rate is negative prognostic factor and depends on qualification to NSS.

references

  1. Szerokość marginesu chirurgicznego u chorych z rakiem nerki poddanych NSS nie wpływa istotnie statystycznie na odsetek miejscowych wznów i progresję choroby ani czas przeżycia pięcioletniego.
  2. W grupie chorych z marginesem do 3 mm jest więcej guzów T1a, RCC-typicum o niskim stopniu złośliwości histopatologicznej G1 przy wyższym czasie obserwacji.
  3. Rodzaj wskazań do NSS rzutuje istotnie na wyniki progresji choroby, czas przeżycia pięcioletniego, i jest czynnikiem wymuszającym szerokość marginesu chirurgicznego.
  4. Odsetek dodatnich marginesów chirurgicznych uzależniony jest od kwalifikacji do NSS i wpływa istotnie na czas przeżycia i gorsze wyniki po operacji.
  5. Piśmiennictwo / References
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correspondence

Mieczysław Fryczkowski
Klinika Urologii w Zabrzu ŚAM w Katowicach
ul. 3 Maja 13/15
41-800 Zabrze
tel./fax (032) 271 65 11
andrzej.kupilas@wp.pl