Positive margins after nephron‐sparing surgery for renal cell carcinoma: long‐term follow‐up of patients on active surveillance

摘要: Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE To analyse our long-term oncological outcomes with active surveillance in patients positive surgical margins (PSMs) after nephron-sparing surgery (NSS) for renal cell carcinoma (RCC), as this situation is a difficult therapeutic dilemma. PATIENTS AND METHODS We performed open NSS masses frozen-section analysis any suspicious zone the bed, followed by extensive argon-beam coagulation. In where final histopathological examination mass revealed PSMs, follow-up consisted computed tomography (CT) every 6 months first 2 years and then annually up to 5 years, thereafter we alternated ultrasonography CT. RESULTS From 1995 2003 had 11 cases microscopic definitive PSMs RCC. Two required nephrectomy (one postoperative bleeding another an elective procedure), so nine were followed. These either operated under (seven) or imperative (two) conditions. The histological subtype was clear three, papillary two, chromophobe two hybrid oncocytic RCC Furhman grade six 3 three. mean size 31.4 mm, stage pT1a six, pT1b one pT3a two. After median 80.5 months, there no local recurrence distant progression. CONCLUSIONS In experience, specimens can be managed conservatively surveillance, achieving excellent results avoiding reoperation without compromising outcomes.