Abstract
Background
To determine the effect of positive surgical margins in patients who undergo a partial
nephrectomy regarding recurrence, overall survival, disease-free survival, recurrence
and progression-free survival, and metastasis-free survival.
Methods
We performed a systematic review accomplishing with Cochrane recommendations. We searched
in Medline, Embase, and central. We also looked for unpublished literature. There
was no language or setting restrictions. We performed a random-effects meta-analysis
for all outcomes.
Results
We included 44 studies for qualitative and quantitative analysis. We found that positive
margins increase the risk of local recurrence (RR 4.14 95%CI 2.75-6.24), recurrence
(RR 4.8 95%CI 3.38-6.62), mortality (RR 1.83 95%CI 1.08-3.1), metastasis (RR 8.1 95%CI
3.88-16.92), and improved the recurrence/progression-free survival (HR 2.9 95%CI 1.88-4.49)
and metastasis-free survival (HR 2.91 95%CI 1.25-6.79) with moderate, moderate, very
low, very low, and high certainty of the evidence, respectively. We found no change
in overall survival (HR 1.48 95%CI 0.98-2.22) with very low certainty of evidence.
Conclusions
A positive margin is an independent predictor of local recurrence, recurrence, mortality,
metastasis, with no effect on overall survival. Therefore, a tailored intense and
prolonged follow-up is mandatory.
Keywords
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Article Info
Publication History
Published online: June 18, 2022
Accepted:
May 29,
2022
Received:
April 23,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
