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Margins - do we understand the story about margins and implications?

Bubbs21
Posts: 44
Joined: Jul 2012

I have heard alot about clear, negative and positive margins.  In my case, I did not have clear margins and yet the doctor professed he got it all and is positive that there is a low level of risk for recurrence.  In fact, with stage 1 (localized and less than 4cm), he states that he favours doing nehpron sparing surgery (NSS) with minimal or no margins. 

This appears to contridict what I had heard about margins on this site and in other research, however, knowing that stats and research can become outdated quickly with RCC and that I have a lot of faith in my surgeon, I looked for literature to better understand the current thinking on margins.  I found many recent articles on margins, but this one appears to be simple to understand and highlights more recent thinking for Mini-margins and nephron sparing suregries (=partial nephrectomy).

The article concludes that " Mini-margin NSS is as safe and effective as 1cm-NSS and RN (radical nephrectomy) in treating early localized RCC 4cm or less. It provides excellent renal function preservation, favorable long-term progression-free survival, lower complication rate, and is not associated with an increased risk of local recurrence."

Happy reading.

Bubbs

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938425/

 

 

Boolea
Posts: 28
Joined: Oct 2012

This posting spoke to the very same concern I had been having about my path lab results, which said Positive, with a question mark after it.  However at my follow-up visit post-op, the doctor was very confident that he got it all.  So I let it be, because at that point I was just focusing on recovery.  Also my tumor, at 3.9 cm, was just on that "border" of early localized RCC.

The article you referenced was encouraging.  I'm not sure what entails a "mini-margin" though.  Maybe I need to pull out my surgery report again.

My other niggling concern: is it better to just remove the kidney with a small to moderate-sized tumor, or peform the partial? I recall wondering about this initially...whether leaving the partial kidney would increase my chances of a recurrence.  I guess I have to say at this point that I still have confidence in my doctor and that he performed the surgery he felt was best for me, given my individual situation, health and age.  And given that my surgery is already a done deal, this may fall into the realm of "move on, Boolea".  :-D

Ms. Boo

 

 

adman's picture
adman
Posts: 267
Joined: Jul 2012

I had a 5.0 cm tumor but they thought it was 6.2cm prior to the actual surgery. 

I had 3 opinions.

- 1 of the Dr's said he could do a kidney sparing surgery

- another Dr was on the fence, he could have gone either way. 

- the 3rd Dr. was adamant that he wanted to do a radical 

the latest research is pushing the 4.0cm rule for 'partials', many of these surgeries are being done above the 4.0cm size. According to the Dr's I spoke with, these are now being done up to 6.0cm's as they are getting better results & post-operative data...i.e., less leakage, less 2nd & 3rd surgeries to go back in to repair leaks, and less cases where they have to do a radical later on due to leakage. 

I ended up having a radical. My margins were clear. Stage 1, Grade 1 Clear Cell RCC. 

garym's picture
garym
Posts: 1651
Joined: Nov 2009

Yeah... 3 years ago mine measured 4.9cm pre-surgery and partial wasn't even discussed, actual measurement from the pathology was 3.9 x 4.2 all clear stage 1, grade 1.

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