Abstract
This study (citation) further solidifies the notion that with adequate expertise, minimally invasive partial nephrectomy is an oncologically sound approach for larger and more complex renal masses. 1 –3 As with prostatectomy and cystectomy, the evidence for partial nephrectomy strongly indicates that positive surgical margins, a common proxy for surgical quality, depends more on patient, tumor, and surgeon factors rather than surgical approach. 4,5
In contrast to the association between aggressive histology and positive surgical margin, the socioeconomic disparities identified in this study have no physiologic explanation. That these data identified higher positive surgical margin rates among less educated, African American patients undergoing surgery at nonacademic and rural hospitals is not novel, yet no less troubling. Unfortunately, the authors only attempt to speculate on why advanced age and receiving care at a nonacademic center may be associated with higher positive margin rate. Although the choice of surgical approach will remain one of surgeon comfort and experience, perhaps we should be calling more attention to the systematic barriers to providing high-quality surgical care to all patients in all settings.