e6e052812751ae5126620fb2909d1553 277713.pdf 8995dce99ffeeea807c114f1dd89ec22d3aa3f6f 277713.pdf e8c6d7759c810f9bf3c827220744460b3a9d7989bcffc243aae756d8fc816e51 277713.pdf Title: Predictors of Positive Surgical Margins after Robot-Assisted Partial Nephrectomy for Localized Renal Tumors: Insights from a Large Multicenter International Prospective Observational Project (The Surface-Intermediate-Base Margin Score Consortium) Subject: Background: To explore predictors of positive surgical margins (PSM) after robotic partial nephrectomy (PN) in a large multicenter international observational project, harnessing the Surface-Intermediate-Base (SIB) margin score to report the resection technique after PN in a standardized way. Methods: Data from consecutive patients with cT1-2N0M0 renal masses treated with PN from September 2014 to March 2015 at 16 tertiary referral centers and included in the SIB margin score International Consortium were prospectively collected. For the present study, only patients treated with robotic PN were included. Uni- and multivariable analysis were fitted to explore clinical and surgical predictors of PSMs after PN. Results: Overall, 289 patients were enrolled. Median (IQR) preoperative tumor size was 3.0 (2.3–4.2) cm and median (IQR) PADUA score was 8 (7–9). SIB scores of 0–2 (enucleation), 3–4 (enucleoresection) and 5 (resection) were reported in 53.3%, 27.3% and 19.4% of cases, respectively. A PSM was recorded in 18 (6.2%) patients. PSM rate was 4.5%, 11.4% and 3.6% in case of enucleation, enucleoresection and resection, respectively. Patients with PSMs had tumors with a higher rate of contact with the urinary collecting system (55.6% vs. 27.3%; p < 0.001) and a longer median warm ischemia time (22 vs. 16 min; p = 0.02) compared with patients with negative surgical margins, while no differences emerged between the two groups in terms of other tumor features (i.e., pathological diameter, PADUA score). In multivariable analysis, only enucleoresection (SIB score 3–4) versus enucleation (SIB score 0–2) was found to be an independent predictor of PSM at final pathology (HR: 2.68; 95% CI: 1.25–7.63; p = 0.04), while resection (SIB score 5) was not. Conclusions: In our experience, enucleoresection led to a higher risk of PSMs as compared to enucleation. Further studies are needed to assess the differential impacts of resection technique and surgeon’s experience on margin status after robotic PN. Keywords: partial nephrectomy; positive surgical margins; renal tumor; robotics; SIB score Author: Fabrizio Di Maida, Riccardo Campi, Brian R. Lane, Ottavio De Cobelli, Francesco Sanguedolce, Georgios Hatzichristodoulou, Alessandro Antonelli, Antonio Andrea Grosso, Sabrina Noyes, Oscar Rodriguez-Faba, Frank X. Keeley, Johan Langenhuijsen, Gennaro Musi, Tobias Klatte, Marco Roscigno, Bulent Akdogan, Maria Furlan, Claudio Simeone, Nihat Karakoyunlu, Martin Marszalek, Umberto Capitanio, Alessandro Volpe, Sabine Brookman-May, Jürgen E. Gschwend, Marc C. Smaldone, Robert G. Uzzo, Alexander Kutikov, Andrea Minervini and SIB International Consortium Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Wed Mar 23 03:56:29 2022 CET ModDate: Wed Mar 23 06:38:50 2022 CET Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 10 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 254281 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- HQBQWV+VnURWPalladioL Type 1 Custom yes yes no 10 0 SKEBEO+URWPalladioL-Bold Type 1 Custom yes yes no 15 0 FIYKTI+URWPalladioL-Roma Type 1 Custom yes yes no 20 0 XFMUWH+URWPalladioL-Ital Type 1 Custom yes yes no 24 0 MCBCCI+SourceSansRoman-Regular Type 1C Custom yes yes no 32 0 MCBCCM+SourceSansRoman.613wght Type 1C Custom yes yes no 36 0 MCBCCO+SourceSansRoman-Bold Type 1C Custom yes yes no 40 0 XPUSBJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 52 0 BSDWLC+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 55 0 PDTLUH+CMSY10 Type 1 Builtin yes yes no 80 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes no 90 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2023-07-21 02:36:42 CEST RepresentationInformation: 277713.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2023-07-20 15:12:45 CEST Size: 254281 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 217 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@44c8afef Item: Title: Materials and Methods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7b69c6ba Children: Item: Title: Patient and Dataset Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@46daef40 Item: Title: Objectives of the Study Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@12f41634 Item: Title: Statistical Analysis Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@13c27452 Item: Title: Results Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@262b2c86 Item: Title: Discussion Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@371a67ec Item: Title: Conclusions Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@5ed828d Item: Title: References Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@50d0686 Info: Title: Predictors of Positive Surgical Margins after Robot-Assisted Partial Nephrectomy for Localized Renal Tumors: Insights from a Large Multicenter International Prospective Observational Project (The Surface-Intermediate-Base Margin Score Consortium) Author: Fabrizio Di Maida, Riccardo Campi, Brian R. Lane, Ottavio De Cobelli, Francesco Sanguedolce, Georgios Hatzichristodoulou, Alessandro Antonelli, Antonio Andrea Grosso, Sabrina Noyes, Oscar Rodriguez-Faba, Frank X. Keeley, Johan Langenhuijsen, Gennaro Musi, Tobias Klatte, Marco Roscigno, Bulent Akdogan, Maria Furlan, Claudio Simeone, Nihat Karakoyunlu, Martin Marszalek, Umberto Capitanio, Alessandro Volpe, Sabine Brookman-May, Jürgen E. Gschwend, Marc C. Smaldone, Robert G. Uzzo, Alexander Kutikov, Andrea Minervini and SIB International Consortium Subject: Background: To explore predictors of positive surgical margins (PSM) after robotic partial nephrectomy (PN) in a large multicenter international observational project, harnessing the Surface-Intermediate-Base (SIB) margin score to report the resection technique after PN in a standardized way. Methods: Data from consecutive patients with cT1-2N0M0 renal masses treated with PN from September 2014 to March 2015 at 16 tertiary referral centers and included in the SIB margin score International Consortium were prospectively collected. For the present study, only patients treated with robotic PN were included. Uni- and multivariable analysis were fitted to explore clinical and surgical predictors of PSMs after PN. Results: Overall, 289 patients were enrolled. Median (IQR) preoperative tumor size was 3.0 (2.3 4.2) cm and median (IQR) PADUA score was 8 (7 9). SIB scores of 0 2 (enucleation), 3 4 (enucleoresection) and 5 (resection) were reported in 53.3%, 27.3% and 19.4% of cases, respectively. A PSM was recorded in 18 (6.2%) patients. PSM rate was 4.5%, 11.4% and 3.6% in case of enucleation, enucleoresection and resection, respectively. Patients with PSMs had tumors with a higher rate of contact with the urinary collecting system (55.6% vs. 27.3%; p < 0.001) and a longer median warm ischemia time (22 vs. 16 min; p = 0.02) compared with patients with negative surgical margins, while no differences emerged between the two groups in terms of other tumor features (i.e., pathological diameter, PADUA score). In multivariable analysis, only enucleoresection (SIB score 3 4) versus enucleation (SIB score 0 2) was found to be an independent predictor of PSM at final pathology (HR: 2.68; 95% CI: 1.25 7.63; p = 0.04), while resection (SIB score 5) was not. Conclusions: In our experience, enucleoresection led to a higher risk of PSMs as compared to enucleation. Further studies are needed to assess the differential impacts of resection technique and surgeon’s experience on margin status after robotic PN. 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