Impact of Positive Surgical Margins on Recurrence and Overall Survival Following Partial Nephrectomy: A Systematic Review and Meta-Analysis.

Abstract

Purpose: Positive surgical margins (PSM) following partial nephrectomy (PN) for renal cell carcinoma (RCC) are a concern due to potential implications for recurrence and survival. This systematic review and meta-analysis assess the impact of PSM on recurrence rates and progression-free survival in RCC patients.

Methods: We conducted a systematic search of PubMed, Embase, Scopus, Cochrane, and Web of Science databases from inception through July 2024. Studies examining recurrence and survival outcomes in RCC patients with and without PSM post-PN were included. A random-effects model was applied to calculate pooled hazard ratios (HR) and 95% confidence intervals (CI) for recurrence and survival.

Results: Thirty studies met the inclusion criteria. Our analysis showed that PSM was significantly associated with a higher risk of local recurrence (HR = 2.13, 95% CI: 1.67-2.72) and a lower recurrence/progression-free survival (HR = 1.70, 95% CI: 1.40-2.07) compared to negative surgical margins. Subgroup analyses indicated consistent results across study designs and RCC histologic subtypes.

Conclusion: The presence of PSM following PN for RCC is associated with a 2.13-fold increase in local recurrence and a 1.7-fold reduction in progression-free survival, emphasizing the need for precise margin management during surgery. These findings highlight the importance of optimizing surgical techniques and considering adjuvant treatment strategies for patients with PSM to improve oncologic outcomes.