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Does a Positive Surgical Margin After Nephron Sparing Surgery Affect Oncological Outcome in Renal Cell Carcinoma? A Systematic Review and Meta-analysis

  • Author Footnotes
    # Nizar Hakam and Nassib Abou Heidar contributed equally to the manuscript.
    Nizar Hakam
    Footnotes
    # Nizar Hakam and Nassib Abou Heidar contributed equally to the manuscript.
    Affiliations
    Division of Urology and Renal Transplantation, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon

    The Breyer Lab, University of California San Francisco, San Francisco, CA
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  • Author Footnotes
    # Nizar Hakam and Nassib Abou Heidar contributed equally to the manuscript.
    Nassib Abou Heidar
    Footnotes
    # Nizar Hakam and Nassib Abou Heidar contributed equally to the manuscript.
    Affiliations
    Division of Urology and Renal Transplantation, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
    Search for articles by this author
  • Joanne Khabsa
    Affiliations
    Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
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  • Layal Hneiny
    Affiliations
    Saab Medical Library, University Libraries, American University of Beirut, Beirut, Lebanon
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  • Elie A. Akl
    Affiliations
    Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon

    Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
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  • Author Footnotes
    1 Professor of Urology and Surgery, Director, Renal Transplantation Unit, American University of Beirut Medical Center, Department of Urology, Carle Foundation Hospital & Clinical Professor of Urology, Carle Illinois College of Medicine, Adjunct Professor of Urology, University of Massachusetts Medical Center, Director Middle East Prostate Cancer Consortium (MEPCC).
    Raja Khauli
    Correspondence
    Address correspondence to: Raja Khauli, M.D., F.A.C.S, Division of Urology and Renal Transplantation, Department of Surgery, American University of Beirut Medical Center, P.O. Box 11-0236/ Riad Solh 1107 2020, Beirut, Lebanon.
    Footnotes
    1 Professor of Urology and Surgery, Director, Renal Transplantation Unit, American University of Beirut Medical Center, Department of Urology, Carle Foundation Hospital & Clinical Professor of Urology, Carle Illinois College of Medicine, Adjunct Professor of Urology, University of Massachusetts Medical Center, Director Middle East Prostate Cancer Consortium (MEPCC).
    Affiliations
    Division of Urology and Renal Transplantation, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
    Search for articles by this author
  • Author Footnotes
    # Nizar Hakam and Nassib Abou Heidar contributed equally to the manuscript.
    1 Professor of Urology and Surgery, Director, Renal Transplantation Unit, American University of Beirut Medical Center, Department of Urology, Carle Foundation Hospital & Clinical Professor of Urology, Carle Illinois College of Medicine, Adjunct Professor of Urology, University of Massachusetts Medical Center, Director Middle East Prostate Cancer Consortium (MEPCC).

      ABSTRACT

      We systematically evaluated the impact of positive surgical margins (PSM) on oncological outcomes after partial nephrectomy for renal cell carcinoma. Forty-two studies comprising 101,153 subjects were included and five distinct meta-analyses were performed. PSM was associated with increased risk of local recurrence (hazard ratio (HR) 6.11—high certainty), metastasis (HR 3.29—moderate certainty), overall relapse (HR 2.25—high certainty), overall mortality (HR 1.30—moderate certainty), and may be associated with increased cancer-specific mortality (HR 1.91—low certainty). Patients with PSM should be counseled for the possibility of additional surgery, novel adjuvant therapies, and more rigorous surveillance.
      Abbreviations: CSM: (cancer-specific mortality), HR: (hazard ratio), NOS: (Newcastle–Ottawa Scale), NSM: (negative surgical margins), NSS: (nephron-sparing surgery), PN: (partial nephrectomy), PRISMA: (preferred reporting items for systematic reviews and meta-analyses), PSM: (Positive surgical margins), RCC: (Renal cell carcinoma)
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