Nephron-sparing surgery (NSS) is the standard treatment in localized renal cancer with cancer-specific survival rates comparable to radical nephrectomy. By providing renal function preservation and reducing the risk of chronic kidney disease, NSS may prevent the risk of cardiovasculer events and death from the cancer. However, NSS can result in incomplete cancer removal in some cases and to consequent positive surgical margin (PSM). Little is known of the natural history of PSM in kidney cancer surgery. With more understanding surgical anatomy of the kidney, improvements in surgical approaches and development of modern imaging techniques, the incidence of PSM decreased to 5%. PSM is frequently observed in high graded tumors and after mandatory indications. The majority of patients with PSM remain without recurrence after NSS and a follow-up strategy seems preferable to surgical intervention. Radical nephrectomy is not the optimal treatment option in PSM. Immediate or delayed surgical treatment should be proposed only in selected high-risk patients. In this review, we aimed to discuss incidence, preoperative and postoperative risk factors, and treatment options of PSM after NSS. (Bulletin of Urooncology 2014;13:165-168)
Keywords: Kidney tumors, nephron sparing surgery, positive surgical margin, treatment