A positive surgical margin associated with an extraprostatic extension of prostate carcinoma is a significant risk for disease progression. What, then, is the risk of a positive margin created by an inadvertent surgical incision into cancerous prostate parenchyma?

2009 ◽  
pp. 34-38
Keyword(s):  
Disease Progression ◽  
Prostate Carcinoma ◽  
Significant Risk ◽  
Surgical Margin ◽  
Positive Margin ◽  
Positive Surgical Margin ◽  
Surgical Incision ◽  
Extraprostatic Extension

scholarly journals The Clinical Impact of pT3a Lesions in Patients With pT3b Prostate Cancer Undergoing Radical Prostatectomy

2021 ◽  
Author(s):  
Numbereye Numbere ◽  
Yuki Teramoto ◽  
Pratik M. S. Gurung ◽  
Takuro Goto ◽  
Zhiming Yang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Bladder Neck ◽  
Tumor Volume ◽  
Specific Antigen ◽  
Surgical Margin ◽  
Clinical Impact ◽  
Outcome Analysis ◽  
Positive Surgical Margin ◽  
Extraprostatic Extension

Context.— Seminal vesicle invasion (SVI) by prostate cancer (pT3b disease) has been considered as a key prognostic factor. Objective.— To assess the clinical impact of T3a lesions (ie, extraprostatic extension other than bladder neck invasion [BNI] or SVI [EPE], microscopic bladder neck invasion [mBNI]) in pT3b disease. Design.— We compared radical prostatectomy findings and long-term oncologic outcomes in 248 patients with pT3b disease, with versus without EPE/mBNI. Results.— Extraprostatic extension/mBNI was found in 219 (88.3%)/48 (19.4%) cases, respectively. Extraprostatic extension was significantly associated with higher preoperative prostate-specific antigen (PSA) level, higher rates of positive surgical margin (pSM) and lymphovascular invasion (LVI), and larger tumor volume. Similarly, mBNI was significantly associated with higher PSA level, higher rates of Grade Group(s) 4-5 or 5, pSM, LVI, and pN1, and larger tumor volume. Significant differences in all of these clinicopathologic features (except lymph node metastasis) between EPE−/mBNI+ or EPE+/mBNI− and EPE+/mBNI+ cases were also observed. Outcome analysis revealed that patients with EPE (P < .001) or mBNI (P < .001) had a significantly higher risk of disease progression than respective controls. Notably, there were significant differences in progression-free survival between EPE−/mBNI+ or EPE+/mBNI− cases and EPE−/mBNI− (P = .001) or EPE+/mBNI+ (P < .001) cases. In multivariate analysis, EPE (hazard ratio [HR] = 6.53, P = .009) and mBNI (HR = 2.33, P = .003), as well as EPE−/mBNI+ or EPE+/mBNI− (HR = 11.7, P = .01) and EPE+/mBNI+ (HR = 25.9, P = .002) (versus EPE−/mBNI−), showed significance for progression. Conclusions.— From these significant findings, we propose a novel pT3b subclassification: pT3b1 (SVI alone without EPE or mBNI), pT3b2 (SVI with either EPE or mBNI), and pT3b3 (SVI with both EPE and mBNI).

Clinical effect of a positive surgical margin without extraprostatic extension after robot-assisted radical prostatectomy

2015 ◽  
Vol 33 (12) ◽  
pp. 503.e1-503.e6 ◽  
Author(s):  
Takeshi Hashimoto ◽  
Kunihiko Yoshioka ◽  
Yutaka Horiguchi ◽  
Rie Inoue ◽  
Ohno Yoshio ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Clinical Effect ◽  
Surgical Margin ◽  
Positive Surgical Margin ◽  
Robot Assisted ◽  
Extraprostatic Extension

Oncologic significance of pathologic T2 positive surgical margin in robotic-assisted laparoscopic prostatectomy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15607-15607
Author(s):  
A. Levinson ◽  
D. S. Berkman ◽  
E. T. Goluboff ◽  
D. B. Samadi
Keyword(s):  
Linear Regression Analysis ◽  
Surgical Margin ◽  
Disease Free Survival ◽  
Positive Margin ◽  
Multiple Linear Regression Analysis ◽  
Positive Surgical Margin ◽  
Robotic Assisted ◽  
Laparoscopic Prostatectomy ◽  
Pathologic Stage

15607 Background: A positive margin (PM) after radical prostatectomy (RP) in organ confined (pT2) prostate cancer (CaP) is considered a surgical error. In addition, capsular incision may occur at a higher frequency with robotic and laparoscopic techniques than with traditional open RP. However, the mechanism and significance of capsular violation may be different between open RP and Robotic Assisted Laparoscopic Prostatectomy (RALP). We sought to determine biochemical disease free survival (BDFS) for patients (pts) who underwent RALP at our institution who had a pT2 PM and compared them to those who did not. Methods: We reviewed our prospective IRB approved database for RALPs performed by a single surgeon. To permit adequate follow-up only cases prior to March 2006 were included. Biochemical failure (BF) strictly defined as any PSA >0.1ng/ml. No pt received adjuvant therapy without a BF. Results: Since Jan 2003, 435 consecutive pts underwent RALP for clinically localized CaP. 211 of these cases were before March 2006, of which 194/211 (92%) had sufficient data for analysis. Mean follow-up was 9.8 mos (range 0.7–41.6). Mean age, preoperative PSA, and path Gleason Score were 60 yrs, 6.6 ng/ml, and 6.9, respectively. Pathologic stages: pT2 77%; pT3a 13%; pT3b 7%, pT4 3%. Overall, 7.2% (14/194) experienced BF at a median of 2.5mos (0.7–15.3). BDFS rates by pathologic stage were pT2 95.3% (142/149), pT3a 91.7% (22/24), pT3b 76.9% (10/13), and pT4 71% (5/7). pT2 pts with a PM had the same rate of BF, (4.4% 1/23), as pT2 pts with negative margins (NM) (4.8% 6/126, p=0.932) and pT3 NM (0% 0/19, p=0.36), but was statistically less than pT3 PM (27.8% 5/18, p=0.035). In multiple linear regression analysis, preoperative PSA >10ng/ml was the most predictive variable of BF even after adjusting for Gleason sum, pathologic stage, and surgical margin status. Conclusions: There may be a different mechanism between a PM in organ confined open RP pts and RALP pts. In our series of RALPs, only one of 23 pT2 PM pts suffered a biochemical recurrence. BDFS for these pts was 95.7%, and did not vary significantly from pT2 NM nor pT3 NM pts. A larger series with longer follow-up will determine whether the oncologic significance of a PM in pT2 RALP pts is different than that of open RP pts. No significant financial relationships to disclose.

scholarly journals Frequency of Positive Surgical Margin at Prostatectomy and Its Effect on Patient Outcome

2011 ◽  
Vol 2011 ◽  
pp. 1-12 ◽  
Author(s):  
Kenneth A. Iczkowski ◽  
M. Scott Lucia
Keyword(s):  
Patient Outcome ◽  
Tumor Cells ◽  
Surgical Margin ◽  
Positive Margin ◽  
Positive Surgical Margin ◽  
Positive Margins ◽  
Operator Experience ◽  
The Past ◽  
Psa Failure ◽  
Main Determinants

A positive surgical margin at prostatectomy is defined as tumor cells touching the inked edge of the specimen. This finding is reported in 8.8% to 42% of cases (median about 20%) in various studies. It is one of the main determinants of eventual biochemical (PSA) failure, generally associated with a doubled or tripled risk of failure. The effect of a positive margin on outcome can be modified by stage or grade and the length, number and location of positive margins, as well as by technical operative approach and duration of operator experience. This paper tabulates data from the past decade of studies on margin status.

scholarly journals LOCATION OF EXTRAPROSTATIC EXTENSION AND POSITIVE SURGICAL MARGIN IN RADICAL PROSTATECTOMY SPECIMENS

2004 ◽  
Vol 95 (1) ◽  
pp. 42-49
Author(s):  
Naotaka Sakamoto ◽  
Yoshihiko Kagawa ◽  
Sachiko Tanaka ◽  
Atsushi Iguchi ◽  
Yoshihiro Hasegawa ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Surgical Margin ◽  
Positive Surgical Margin ◽  
Extraprostatic Extension

Rate of Re-excision after Breast-conserving Surgery for Invasive Lobular Carcinoma

2013 ◽  
Vol 79 (10) ◽  
pp. 1119-1122 ◽  
Author(s):  
Morcos L. Wanis ◽  
Jennifer A. Wong ◽  
Samuel Rodriguez ◽  
Jasmine M. Wong ◽  
Brice Jabo ◽  
...  
Keyword(s):  
Invasive Lobular Carcinoma ◽  
Ductal Carcinoma ◽  
Lobular Carcinoma ◽  
Surgical Margin ◽  
Positive Margin ◽  
Breast Conserving Surgery ◽  
Positive Surgical Margin ◽  
Close Margin ◽  
Cross Sectional ◽  
Positive Margins

Invasive lobular carcinoma (ILC) accounts for approximately 5 to 20 per cent of all breast cancers and is often multicentric. Despite pre- and intraoperative assessments to achieve negative margins, ILC is reported to be associated with higher rates of positive margin. This cross-sectional study examined patients with breast cancer treated at our institution from 2000 to 2010. The objective was to investigate the rate of re-excision resulting from positive or close margin (1 mm or less) in patients who underwent breast-conserving surgery (BCS) for ILC compared with invasive ductal carcinoma (IDC) and ductal carcinoma in situ (DCIS). Of the 836 patients treated, 416 patients underwent BCS. The rate of re-excision after BCS for ILC was 35.1 versus 17.7 per cent for IDC and 20.0 per cent for DCIS ( P = 0.04). Re-excisions were more often performed for positive margin in patients with ILC (11 of 37 [29.7%]) versus IDC (36 of 334 [10.8%]) and DCIS (five of 45 [11.1%];( P = 0.004). In this single-institution review, BCS for ILC had significantly higher rates of re-excision as a result of positive margins when compared with IDC and DCIS. Tumor size greater than 2 cm and lymph node involvement were identified as factors associated with positive surgical margin in ILC. The higher possibility of positive margins and the need for additional procedures should be discussed with patients undergoing BCS for ILC.

Oncological outcomes of positive surgical margins in partial nephrectomy for renal cell carcinoma.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e16079-e16079 ◽  
Author(s):  
Henrique T. S. Nonemacher ◽  
Mauricio Cordeiro ◽  
George Lins de Albuquerque ◽  
Fabio Galucci ◽  
Paulo Afonso de Carvalho ◽  
...  
Keyword(s):  
High Risk ◽  
Partial Nephrectomy ◽  
Surgical Margin ◽  
Positive Margin ◽  
Disease Recurrence ◽  
Surgical Margins ◽  
Positive Surgical Margin ◽  
Positive Surgical Margins ◽  
Risk Of Disease ◽  
Risk Of Relapse

e16079 Background: The prognostic significance and optimal management of positive surgical margins following partial nephrectomy remain controversial. The association between positive margin and risk of disease recurrence in patients with clinically localized renal neoplasm undergoing partial nephrectomy was evaluated. Methods: We analyzed the records of 429 patients cases of non-metastatic renal cell carcinoma who underwent partial nephrectomy (PN) at our institution, from 2001 to 2016. Recurrence free-survival was evaluated using Kaplan–Meier method and the log rank test and Cox models adjusting for tumor size, grade, histology, pathological stage, focality and laterality. The relationship between positive margin and risk of relapse was evaluated independently for pathological high risk (Fuhrman grades III-IV) and low risk (Fuhrman grades I-II) groups Results: A positive surgical margin was found in 55 (12.8%) patients. Recurrence developed in 26 (6%) patients during a median follow up of 39 months. A positive margin was associated with an increased risk of relapse on multivariable analysis (HR 3.19, CI 95% 1.21 – 7.61 p=0.02) (Table). In a stratified analysis based on pathological features, a positive surgical margin was significantly associated with a higher risk of recurrence in cases of high risk (HR 13.8, CI 95% 4.19–45.9, p = 0.0005). Conclusions: Positive surgical margins after partial nephrectomy increase the risk of disease recurrence, primarily in patients with high-risk pathological features. [Table: see text]

Mammary phyllodes tumour: a 15-year multicentre clinical review

2017 ◽  
Vol 71 (6) ◽  
pp. 493-497 ◽  
Author(s):  
Michael Co ◽  
Clement Chen ◽  
Julia Y Tsang ◽  
Gary Tse ◽  
Ava Kwong
Keyword(s):  
Risk Factors ◽  
Local Recurrence ◽  
Tumour Size ◽  
Significant Risk ◽  
Surgical Margin ◽  
Breast Conserving Surgery ◽  
Positive Surgical Margin ◽  
Biological Behaviour ◽  
Phyllodes Tumour ◽  
Long Term Prognosis

AimsPhyllodes tumour (PT) is an uncommon fibroepithelial tumour of the breast. It has a spectrum of aggressiveness in biological behaviour with chance of local recurrence and, occasionally, metastasis.MethodsA 15-year retrospective review from a multicentre database in Hong Kong was performed.ResultsClinical and pathological records of 465 patients with 469 PTs between 1998 and 2014 were reviewed. Median age of occurrence was 44 years (range 12–86 years). 281 (59.9%) PTs were benign, 124 (26.4%) were borderline and 64 (13.6%) were malignant. About half of all PTs (239, 51.5%) were between 2 and 5 cm while another 186 (40.1%) were >5 cm in size. Most PT (84.6%) were radiologically benign. Breast-conserving surgery (BCS) was feasible in 384 (82%) patients, whereas 84 (18%) patients had mastectomy. Multivariate analysis found that positive surgical margin (P<0.001) and BCS (P<0.001) were the only significant risk factors for local recurrence, while large tumour size (P=0.008) and malignant PT histotype (P<0.001) were the only significant risk factors for metastasis. Long-term prognosis of benign and borderline PT was excellent. After median follow-up interval of 85 months (range 12–180 months), the disease-specific survival of benign, borderline and malignant PT were 99.6%, 100% and 90.6%, respectively.ConclusionsLocal recurrence of PTs occurs irrespective of the tumour grade. Surgical margin is the only amendable factor to reduce the chance of recurrence.

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