Abstract
BACKGROUND AND OBJECTIVE: Incising or breaking a tumor during surgery for renal cell carcinoma (RCC) is considered an adverse event. The aim of our study was to examine oncological outcomes for patients with accidental tumor incision (ATI) during partial nephrectomy (PN) for cT1 RCC. METHODS: We conducted a retrospective single-center study of patients who underwent open, laparoscopic, or robot-assisted PN for cT1a-b RCC. The cohort was divided into groups with and without ATI during PN. The Kaplan-Meier method and a log-rank test were used to estimate and compare recurrence-free survival (RFS) and cancer-specific survival (CSS) for the two groups. KEY FINDINGS AND LIMITATIONS: Among 813 patients, ATI was recorded for 103 cases (13%). Disease recurrence during follow-up occurred in 15 patients in the ATI group and 15 in the group without ATI. RFS differed significantly between the groups according to Kaplan-Meier analysis (p < 0.001) during median follow-up of 52 mo. ATI was associated with larger tumor diameter and higher RENAL score. The difference in CSS between the groups was not statistically significant (p = 0.8). Limitations of the study include the possibility of ATI cases being missed if not reported by the surgeon. CONCLUSIONS AND CLINICAL IMPLICATIONS: Our results demonstrate that ATI during PN is associated with greater risk of disease recurrence in T1 RCC, even though there was no significant difference in CSS over intermediate follow-up. Clinicians should take intraoperative precautions to minimize ATI and consider extended surveillance for patients in whom ATI occurs. Further research is warranted to explore preventative strategies and the long-term impact of ATI on survival. PATIENT SUMMARY: We looked at cancer control outcomes after accidental incision into a tumor (ATI for short) during partial kidney removal for kidney cancer. The rate of cancer recurrence was higher in the group with ATI than in the group without ATI.