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KMID : 1001020090070020055
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Korean Journal of Urological Oncology
2009 Volume.7 No. 2 p.55 ~ p.60
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Management of Post-operative Surgical Margin Positive Cases in RCC: Radical or Partial Nephrectomy
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Kwon Tae-Gyun
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Abstract
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Surgical resection remains the standard treatment for clinically localized renal cell carcinoma. Pathological features of the surgical specimen, including the margin status, play an important role in determining the patient’s prognosis. Negative surgical margins have traditionally been thought to maximize the efficacy of treatment. Initial concerns that partial nephrectomy might have high local recurrence rates compared with radical nephrectomy have now been minimized as a result of technological advances and refinements in surgical technique. Current concerns in relation to partial nephrectomy include the width of parenchymal tissue that should be removed to avoid positive surgical margins, effects of positive margins on recurrence-free survival, and the role of intra-operative frozen-section analysis. Recent reports show that the width of the surgical margin in partial nephrectomy does not seem to affect the risk of local tumor recurrence, and not all cases of positive surgical margins consequently lead to tumor recurrence. Intraoperative frozen-section analysis is not definitive and its value in guiding the surgical management of renal tumors remains to be defined. Intraoperative use of ultrasound, cold-scissor parenchymal transection, selective renal artery embolization, and hilar clamping to achieve clear visibility, may minimize the risk of positive surgical margins during partial nephrectomy.
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KEYWORD
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Renal cell carcinoma, Partial, Radical, Surgical margin
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