Positive surgical margins after partial nephrectomy for renal cell carcinoma: a systematic review and meta-analysis

Purpose: To compare the outcomes of prognosis of positive surgical margins (PSM) and negative surgical margins (NSM) after partial nephrectomy (PN). We performed this study to assess local recurrence, distant recurrence and survival rates after PN. Materials and Methods: We searched PubMed, Web of science and the Cochrane Library. Three independent reviewers extracted data using a standardized form. Quality of the selected studies was assessed using the Newcastle-Ottawa Scale (NOS) for nonrandomized studies. Results: A total of 17 studies and 8156 patients were included. All studies were based on non-randomized, retrospective cohorts and the methodological quality varied. When analyzing recurrence rates, the PSM group had higher rates of local recurrence (P < 0.00001; RR: 4.83), distant recurrence (P < 0.00001; RR: 5.99) and overall recurrence (P < 0.00001; RR: 3.76). For survival analysis, the PSM group had a lower overall survival (OS) rate compared to the NSM group (P = 0.03; RR: 0.63). There was no significant difference between the two groups regarding the rate of cancer-specific survival (CSS) (P = 0.40; RR: 0.99). Conclusions: This meta-analysis showed that PSM after PN increases the risks of local and distant recurrences after PN. In addition, patients with PSM after PN had poorer OS. However, PSM did not appear to influence CSS. Active surveillance may not be recommended for patients with PSM after PN. To acquire more reliable outcomes of prognosis for patients with PSM after PN, large-scale clinical studies with long-term follow-up are needed.