Impact of Surgical Margins on Overall Survival Following Kidney Tumor Resection

Introduction Kidney tumor resection is a primary treatment for localized renal cell carcinoma, aimed not only at removing the tumor but also at preserving kidney function[1]. During surgery, the main objective is to excise the tumor with clean surgical margins. Leaving a positive resection margin is believed to increase the risk of cancer recurrence[2]. Nevertheless, the effect of surgical margins on overall survival (OS) remains a subject of ongoing debate. While some studies suggest that positive margins may negatively impact OS, others indicate minimal influence when appropriate follow-up and adjuvant treatments are employed. Aim To assess how surgical margins influence overall survival in renal cancer patients, aiming to understand their significance for optimizing surgical strategies and improving long-term outcomes. Methods This retrospective study included 768 patients who underwent partial nephrectomy due to kidney cancer at a tertiary university center from 2012 to 2023. The primary endpoint was overall survival, defined as the time from surgery to the last follow-up or death. Survival status (alive or deceased) was recorded and Kaplan-Meier curves were generated to estimate 5- and 10-year OS rates. The log-rank test was used to compare survival outcomes between patients with positive surgical margins and negative surgical margins. Clinical and pathological parameters were analyzed for comparison between the two groups. A p-value <0.05 was considered statistically significant. Results The study population consisted of 1065 patients who underwent partial nephrectomy. 768 patients (72%) had malignant tumors, while 28% were benign. The median age of the patients was 63.25 years (range: 29–85), and the median tumor size was 3.29 cm. Pathological staging revealed pT1a in 76% of cases, pT1b in 16.6%, and pT3 in 7.1%. The dominant histological type was clear cell carcinoma, accounting for 77.1% of cases. Positive surgical margins (R1) were observed in 95 patients (12.2%). The estimated 5-year and 10-year clinical progression-free survival (CPFS) rates for the entire cohort were 91.41% and 85.94%, respectively. No statistically significant difference in CPFS was noted between patients with negative surgical margins (R0) and those with positive margins (R1). The 5-year CPFS was 89.4% for R0 and 86.6% for R1, while the 10- year CPFS was 73.6% for R0 and 59.2% for R1. p = 0.331 Conclusions In the analyzed patient group, surgical margin status after partial nephrectomy was not found to have a statistically significant impact on overall survival. These results indicate that, with proper monitoring and care, positive surgical margins might not negatively affect long-term survival outcomes in patients undergoing kidney tumor removal.