PHILADELPHIA (April 15, 2020) – A study on partial nephrectomy techniques by Alexander Kutikov, MD, FACS, chief of the Division of Urology and Urologic Oncology at Fox Chase Cancer Center and a member of the Molecular Therapeutics Program, was recently published after years of collaboration involving centers in the United States and Europe.
The study examined how the resection technique used during partial nephrectomy might affect operative outcomes and surgical margins. While this study is new, this collaborative approach to nephrectomy dates back many years, Kutikov said.
Kutikov collaborated with Andrea Minervini, MD, an associate professor of Urology at the University of Florence, Italy, over several years in pursuit of optimal surgical strategies for kidney cancer. Kutikov met Minervini, the study’s lead author, while traveling in Europe and the two struck up a friendship.
“We talked about how different centers in the United States, Europe, and around the world approached surgical approaches to kidney tumors a little differently, and how everybody thought their approach was the best approach,” Kutikov said. “We decided that instead of arguing about which way was better, we should figure out how to better identify and standardize reporting and then compare results.”
As one of their first projects, Kutikov and Minervini worked with their teams to develop the Surface-Intermediate-Base (SIB) Margin Score, which attempts to standardize reporting of nephron-sparing surgery resection techniques. These techniques are typically defined as enucleation, enucleoresection, and resection.
To get an SIB score, the surgeon does a visual analysis of the renal mass after partial nephrectomy and assigns a score while in the operating room. This score has been validated and shown to correctly discriminate among different resection techniques.
“We were able to show that what the surgeon documented in the OR by observation with the naked eye correlated with what the pathologist saw under the microscope,” Kutikov said. Because of that, the study allows other studies to be conducted using these standardized scores to compare outcomes across centers.
“This is the first time we are able to standardize reporting across the world, help surgeons understand what they are actually doing, and compare results,” Kutikov said.
For example, some centers report that they try to avoid enucleation, but these studies have shown that upon closer inspection, enucleation may occur inadvertently. “Now that we have started documenting what we are doing, our results can become more meaningful,” Kutikov said. “We hope to continue to collaborate across the Atlantic to improve cancer care together.”
The study, “Impact of Resection Technique on Perioperative Outcomes and Surgical Margins after Partial Nephrectomy for Localized Renal Masses: A Prospective Multicenter Study,” was published in The Journal of Urology, published by Wolters Kluwer.