Current strategies to diagnose and manage positive surgical margins and local recurrence after partial nephrectomy
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:...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-07-01
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| Series: | Asian Journal of Urology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214388222000406 |
| _version_ | 1818084920532140032 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Umberto Carbonara |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-10T20:01:33Z |
| format | Article |
| id | doaj.art-cef652173ddb458b8b042241cf72a0bd |
| institution | Directory Open Access Journal |
| issn | 2214-3882 |
| language | English |
| last_indexed | 2024-12-10T20:01:33Z |
| publishDate | 2022-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Asian Journal of Urology |
| spelling | doaj.art-cef652173ddb458b8b042241cf72a0bd2022-12-22T01:35:31ZengElsevierAsian Journal of Urology2214-38822022-07-0193227242Current strategies to diagnose and manage positive surgical margins and local recurrence after partial nephrectomyUmberto Carbonara0Daniele Amparore1Cosimo Gentile2Riccardo Bertolo3Selcuk Erdem4Alexandre Ingels5Michele Marchioni6Constantijn H.J. Muselaers7Onder Kara8Laura Marandino9Nicola Pavan10Eduard Roussel11Angela Pecoraro12Fabio Crocerossa13Giuseppe Torre14Riccardo Campi15Pasquale Ditonno16European Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group; Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy; Corresponding author. Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy.European Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group; Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, ItalyDepartment of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, ItalyEuropean Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group; Department of Urology, San Carlo Di Nancy Hospital, Rome, ItalyEuropean Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group; Division of Urologic Oncology, Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, TurkeyEuropean Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group; Department of Urology, University Hospital Henri Mondor, APHP, Créteil, FranceEuropean Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group; Department of Urology, SS Annunziata Hospital, ''G. D'Annunzio'' University of Chieti, Chieti, ItalyEuropean Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group; Department of Urology, Radboud University Medical Center, Nijmegen, the NetherlandsEuropean Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group; Department of Urology, Kocaeli University School of Medicine, Kocaeli, TurkeyEuropean Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group; Department of Medical Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, ItalyEuropean Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group; Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, ItalyEuropean Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group; Department of Urology, University Hospitals Leuven, Leuven, BelgiumEuropean Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group; Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, ItalyDepartment of Urology, Magna Graecia University of Catanzaro, Catanzaro, ItalyDepartment of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, ItalyEuropean Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, ItalyDepartment of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, ItalyObjective: 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.http://www.sciencedirect.com/science/article/pii/S2214388222000406Positive surgical marginLocal recurrencePartial nephrectomyRadical nephrectomyRobot-assisted partial nephrectomy |
| spellingShingle | 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 Current strategies to diagnose and manage positive surgical margins and local recurrence after partial nephrectomy Asian Journal of Urology Positive surgical margin Local recurrence Partial nephrectomy Radical nephrectomy Robot-assisted partial nephrectomy |
| title | Current strategies to diagnose and manage positive surgical margins and local recurrence after partial nephrectomy |
| title_full | Current strategies to diagnose and manage positive surgical margins and local recurrence after partial nephrectomy |
| title_fullStr | Current strategies to diagnose and manage positive surgical margins and local recurrence after partial nephrectomy |
| title_full_unstemmed | Current strategies to diagnose and manage positive surgical margins and local recurrence after partial nephrectomy |
| title_short | Current strategies to diagnose and manage positive surgical margins and local recurrence after partial nephrectomy |
| title_sort | current strategies to diagnose and manage positive surgical margins and local recurrence after partial nephrectomy |
| topic | Positive surgical margin Local recurrence Partial nephrectomy Radical nephrectomy Robot-assisted partial nephrectomy |
| url | http://www.sciencedirect.com/science/article/pii/S2214388222000406 |
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