Concordance between intraoperative macroscopic evaluation and permanent section analysis of tumor bed margin in partial nephrectomy: A prospective study.

Abstract

Objectives: To evaluate the concordance between the intraoperative visual assessment of the tumor bed for completeness of resection following partial nephrectomy and the permanent section analysis of biopsies taken from the tumor bed.

Methods: Patients undergoing partial nephrectomy at 2 university hospitals were prospectively enrolled. R.E.N.A.L. nephrometry score of tumors were calculated according to preoperative imaging. Masses were resected either by enucleation or with a safety margin. To ensure accurate excisional biopsy from the entire tumor bed, all resections were performed using the open technique. After tumor excision and confirmation of complete resection through gross inspection, 4 samples-1 from each quadrant of the tumor bed-were taken and sent for permanent section analysis. The concordance between the surgeons' visual inspection and final pathological analysis was then evaluated RESULTS: A total of 52 partial nephrectomies were included in this study. The mean tumor size was 49.5±22.6mm with a mean R.E.N.A.L nephrometry score of 7.13±1.93. Masses were removed by enucleation in 21 cases (40.4%) and with a safety margin in 31 cases (59.6%). Nine masses (17.3%) were benign, and 43 (82.7%) were renal cell carcinomas. None of the tumor bed biopsies were positive, indicating 100% concordance between the surgeons' visual inspection and the final pathological analysis.

Conclusion: Our findings suggest that the surgeons' macroscopic evaluation of the tumor bed during partial nephrectomy is a reliable method for confirming complete resection. Performing biopsies from the tumor bed to confirm negative margins does not appear to provide additional diagnostic value.