The use of robotic tumor enucleation conferred favorable long-term surgical margins and local recurrence rates in patients with sporadic renal cell carcinoma (RCC), according to the results of a single-center Italian study.1 The findings were published online September 27, 2018, in Urologic Oncology.
Patients undergoing robotic tumor enucleation with no ablation of the tumor bed were prospectively selected between 2011 and 2013; 4 surgeons at a single institution performed all procedures. Study end points included pattern of pseudocapsule (PC) invasion, thickness of healthy renal margin removed with the tumor, margin status, and recurrence rate.
In total, 127 patients had complete data available for analysis. Researchers found 95% of tumors (121 of 127) to have a distinct peritumoral PC with a median thickness of 0.28 mm (IQR, 0.14-0.45). For 19.8% of tumors (24 of 121), complete PC invasion was found. A multivariate analysis showed a significant association between PC invasion and increasing tumor diameter, endophytic rate greater than 50%, and papillary histology.
Robotic tumor enucleation achieved negative surgical margins in 97.5% of tumors. After a median follow-up of 61 months, no patients had local recurrence at the enucleation site; 3 patients had renal recurrence, and 3 had systemic recurrence. One patient died from metastatic RCC at follow-up.
The study authors acknowledged, “Our results might not be applicable to all surgeon or center-related scenarios” because the study is based on only 4 surgeons at a referral, high-volume center.
“Although our findings need to be confirmed by larger studies with longer follow-up, robotic tumor enucleation appears oncologically safe in experienced hands for the treatment of sporadic RCC,” the study authors concluded.
- Minervini A, Campi R, Di Maida F, et al. Tumor–parenchyma interface and long-term oncologic outcomes after robotic tumor enucleation for sporadic renal cell carcinoma [published online September 27, 2018]. Urol Oncol. doi: 10.1016/j.urolonc.2018.08.014