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Mari et al. Mini-invasive Surg 2024;8:7 https://dx.doi.org/10.20517/2574-1225.2023.103 Page 5 of 10

In Table 2, surgical details and histopathology were reported. Pedicle clamping showed 217 (13.5%) patients
were off-clamp and 1,394 (86.5%) were on-clamp. The median warm ischemia time was 16 min (IQR:
10-21). A retroperitoneal access was employed in 138 (8.5%) patients. Clear cell RCC was the predominant
histotype, seen in 1,134 (70.4%) patients. SIB score distribution revealed that 1,129 (70.1%) patients had a
score of 0-2, 468 (29%) had a score of 3-4, and 14 (0.9%) had a score of 5. The PSM was observed in 109
(6.7%) patients.

Table 3 displayed two models of the multivariable logistic regression analysis.

In the initial model, imperative surgical indication exhibited an OR of 6.06 (95%CI: 2.58-14.22, P < 0.001).
SIB > 1 had an OR of 2.37 (95%CI: 1.43-3.92, P = 0.001), and off-clamp tumor resection demonstrated an
OR of 3.00 (95%CI: 1.41-6.39, P = 0.004). The PADUA score resulted in an OR of 1.10 (95%CI: 1.03-1.17,
P = 0.006). Age and the American Society of Anesthesiologists (ASA) score did not show statistical
significance at multivariable analysis. In the second model, the PADUA score was replaced by collecting
system tumor compression as a significant predictor (OR 1.34, 95%CI 1.12-1.84, P = 0.001), while tumor
diameter did not reach significance at multivariable analysis.

DISCUSSION
In oncology surgical practices, the comprehensive excision of tumors significantly influences the surgical
efficacy. In PN, notwithstanding the absence of consistent consensus in clinical studies, a heightened
likelihood of local recurrence appears to be associated with patients presenting PSMs . It is pertinent to
[13]
highlight that empirical evidence from various research studies indicates an elevated risk of recurrence for
patients with PSMs, especially in the context of high-risk tumors characterized by determinants that
intrinsically exhibit a pronounced relapse potential, such as escalated tumor dimensions, pT3a stage, and
elevated grading [14,15] . Conversely, in primary tumors of a lower grade, PSMs are postulated to exhibit
[16]
reduced malignant potential owing to a diminished rate of cancer progression . Furthermore, the
obliteration of malignant cells due to coagulation, mechanical perturbations, or induced ischemic damage
during nephron-sparing surgery (NSS) might curtail the persistence and proliferation of neoplastic cells at
[17]
the excision margin .
In our study involving 1,611 patients, demographic and clinical characteristics were extensively analyzed.
Notably, 109 (6.7%) of them had PSMs. Within the realm of surgical oncology, understanding the influence
of various factors on outcomes, especially when dealing with PSMs, is crucial. Our multivariable logistic
regression analysis to detect clinical predictive factors associated with a higher rate of PSMs revealed several
pivotal findings.

The SIB score is an evaluative measure derived post-surgery that standardizes the thickness of healthy renal
margins assessment around the tumor. In simple terms, it categorizes specimens into enucleation,
enucleoresection, or resection based on the aggregate score of three distinct macro-areas. Our analysis
highlighted a notable odds ratio (OR) of 2.37 for SIB > 2 (P = 0.001), highlighting its consequential influence
on PSMs. The reason for such a result warrants an in-depth analytical discussion: indeed, the
uncomplicated enucleation of the tumor along the pseudocapsule, in contrast to a conventional excision of
the adjacent healthy parenchyma, might allow for better respect of the natural cleavage plane. This approach
reduces the risk of inadvertently penetrating the neoplasm, especially in instances of anomalous
configurations, and inadvertently leaving remnants of the SM.