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Master Thesis

MARGINS : impact oncologique des marges chirurgicales dans la néphrectomie partielle robot-assistée, une étude ancillaire du réseau multicentrique uroCCR

Abstract : Background: the oncological impact of positive surgical margins (PSMs) after robot-assisted partial nephrectomy (RAPN) is still under debate. Objectives: comparing PSMs and Negative Surgical Margins (NSMs) in terms of recurrence-free survival (RFS), metastasis-free survival (MFS) and overall survival (OS) after RAPN. Evaluate the risk factors for a PSM to occur. Design, setting, and participants: ancillary study within the UroCCR database involving 26 centers. We reviewed the charts of 2673 patients who underwent RAPN between April 2010 and February 2021. Patients with benign or multiple tumors, open surgery conversion, metastasis at diagnosis (cM+) or total nephrectomy were excluded. Intervention: two groups were compared: PSM and NSM. Outcome measurements and statistical analysis: prognostic factors were assessed using, Kaplan-Meyer curves with log-Rank test, cox hazard proportional risk model and logistic regression after univariate comparison. There were 159 patients in the PSM group (6.3 %) and 2514 NSM. Median follow-up was 20 (9-38) months after RAPN. There was no difference according to age at surgery (59.5 vs 60.1, p=0,513), ASA (p=0,675), cTNM (p=0,268) , but a difference was observed for the RENAL Score (6 vs 7, p=0,034), as well as for the retroperitoneal approach (12.8% vs 6.4% p=0,008), on-clamp procedure (92.4% vs 82.8% p=0,003), warm ischemia time (21.2 vs 18.3, p<0,001) or complications during surgery (PSM : 7.6% vs NSM : 3.8%, p=0,032). RCC type (59.7% vs 69.1%, p=0,018) and chromophobe type (chRCC) (18.2% vs 9.0%, p<0,001) also showed an association with PSM. Kaplan-Meier curves and analysis suggest that RFS, MFS and OS are not affected by a PSM (respective p=0,21; 0,72; 0,44). In multivariate analysis predictors of PSM were lower RENAL score (p<0,001), warm ischemia time (WIT) (p=0,02) and chromophobe type (chCCR) (p=0,02). Conclusions: predictors of PSM seems to be lower RENAL score, a longer WIT and a histology type: chCCR but it does not seem to affect the oncological outcome. Patient summary. Impact of PSM after RAPN is often debated. Our series seems to show no impact of PSM on RFS, MFS or OS. However, predictors of PSM seems to be lower RENAL score, a retroperitoneal approach, a longer WIT and a histology type: chromophobe
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03377927
Contributor : Bibliothèque Universitaire de Médecine Nice Connect in order to contact the contributor
Submitted on : Thursday, October 14, 2021 - 1:12:21 PM
Last modification on : Saturday, November 6, 2021 - 3:23:08 AM

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2021NICEM096.pdf
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  • HAL Id : dumas-03377927, version 1

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Arnoult Morrone. MARGINS : impact oncologique des marges chirurgicales dans la néphrectomie partielle robot-assistée, une étude ancillaire du réseau multicentrique uroCCR. Human health and pathology. 2021. ⟨dumas-03377927⟩

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