938 When should a positive surgical margin (SM) ring a bell? An analysis of a multi-institutional Robotic-Assisted Laparoscopic radical Prostatectomy (RALP) database

2015 ◽  
Vol 14 (2) ◽  
pp. e938
Author(s):  
F. Abdollah ◽  
A. Sood ◽  
J. Sammon ◽  
D.E. Klett ◽  
D. Pucheril ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Surgical Margin ◽  
Laparoscopic Radical Prostatectomy ◽  
Positive Surgical Margin ◽  
Robotic Assisted

PATIENTS WITH PRIOR TURP UNDERGOING ROBOTIC ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY HAVE HIGHER POSITIVE SURGICAL MARGIN RATES

2008 ◽  
Vol 179 (4S) ◽  
pp. 606-606 ◽  
Author(s):  
Lance J Hampton ◽  
Ken Jacobsohn ◽  
Rebecca A Nelson ◽  
Laura E Crocitto ◽  
Roger W Satterthwaite ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Surgical Margin ◽  
Laparoscopic Radical Prostatectomy ◽  
Positive Surgical Margin ◽  
Robotic Assisted

A multi-institutional study of 3,794 patients undergoing robotic-assisted laparoscopic radical prostatectomy to determine the surgical learning curve for positive margins and operating time.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 102-102 ◽  
Author(s):  
P. Sooriakumaran ◽  
M. John ◽  
R. Leung ◽  
D. Peters ◽  
D. Lee ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Learning Curve ◽  
Operating Time ◽  
Surgical Margin ◽  
Learning Curves ◽  
Laparoscopic Radical Prostatectomy ◽  
Positive Surgical Margin ◽  
Robotic Assisted ◽  
Surgeon Experience ◽  
Surgical Learning

102 Background: The surgical learning curve for robotic assisted laparoscopic radical prostatectomy (RALP) is often cited as being shorter than for other surgical modalities. However, while this appears true with regards to surgical safety, the learning curve for more refined variables like positive surgical margin (PSM) rate and operative time (OT) is not well established. Our objective was to assess the surgical learning curve for RALP in terms of these parameters. Methods: We performed a retrospective cohort study of 3,794 patients who underwent RALP between Jan 2003 and Sep 2009 by three surgeons (DL, PW, AKT) from three centers (UPenn, Karolinska, Cornell). Mean overall PSM rates and mean overall OT were calculated for all three surgeons at intervals of 50 RALPs per surgeon, and learning curves for these means were fit using a loess method. R version 2.71 was used for all statistical analysis. Results: The learning curve for PSM rates for all patients demonstrated improvements that continued with greater surgeon experience, with over 1,600 cases required to get a PSM rate <10%. When only pT3 patients were evaluated, the learning curve started to plateau after 1,000-1,500 cases. Mean OT plateaued after 750 cases although with further surgical experience the OTs started to climb again. Conclusions: The learning curve for RALP is not as short as previously thought, and a large number of cases are needed to get PSM rates and OTs to a minimum. This suggests that RALP should be performed by high volume surgeons in order to optimize patient outcomes. [Table: see text]

QUALITY IMPROVEMENT IN LAPAROSCOPIC RADICAL PROSTATECTOMY FOR pT2 PROSTATE CANCER: IMPACT OF VIDEO DOCUMENTATION REVIEW ON POSITIVE SURGICAL MARGIN

2005 ◽  
Vol 173 (3) ◽  
pp. 765-768 ◽  
Author(s):  
KARIM TOUIJER ◽  
KENTARO KUROIWA ◽  
JEFFERY W. SARANCHUK ◽  
WALEED A. HASSEN ◽  
EDOUARD J. TRABULSI ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Quality Improvement ◽  
Radical Prostatectomy ◽  
Surgical Margin ◽  
Laparoscopic Radical Prostatectomy ◽  
Positive Surgical Margin ◽  
Video Documentation

Nomograms to predict 3-year biochemical recurrence after robotic-assisted laparoscopic radical prostatectomy based on preoperative and perioperative variables of 774 patients.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 115-115
Author(s):  
P. Sooriakumaran ◽  
M. John ◽  
A. Srivastava ◽  
Y. El-Douaihy ◽  
S. Grover ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Biochemical Recurrence ◽  
Perineural Invasion ◽  
Clinical Stage ◽  
Surgical Margin ◽  
Margin Status ◽  
Laparoscopic Radical Prostatectomy ◽  
Nerve Sparing ◽  
Robotic Assisted ◽  
Psa Density

115 Background: Predictors of biochemical recurrence after robotic-assisted laparoscopic radical prostatectomy (RALP) are not well reported in the literature. We wanted to investigate preoperative predictors as well as the influence of nerve sparing and positive surgical margin status on 3-year biochemical recurrence. Methods: 774 patients with at least 3 year follow up had undergone RALP by a single surgeon at our institution. Biochemcial recurrence was defined as a postoperative PSA >0.2 ng/ml. Multivariable logistic regression models were used to develop the biochemical recurrence predictive nomograms: nomogram 1- age, BMI, PSA density, clinical stage, biopsy Gleason, percent positive cores, perineural invasion; nomogram 2- age, BMI, PSA density, clinical stage, biopsy Gleason, percent positive cores, perineural invasion, nerve sparing, positive surgical margins (none, unifocal, or multifocal). The predictive accuracy of the models was assessed in terms of discrimination and calibration. Results: Both nomograms discriminated well between patients that recurred and those that did not (bootstrap corrected c-indices of 0.766 and 0.806 for nomograms 1 and 2 respectively). Nomogram 1 was well calibrated, but nomogram 2 over- predicted the probability of biochemical recurrence in patients at >30% risk. Conclusions: Our nomogram based on age, BMI, PSA density, clinical stage, biopsy Gleason, percent positive cores, and perineural invasion on preoperative biopsy has a good predictive ability to differentiate between RALP-treated patients that biochemically recur by 3 years from those that do not. Adding nerve sparing and surgical margin status further improved discriminatory ability but at the expense of over-prediction for patients at high risk. These nomograms may be used to guide the use of nerve sparing and the management of positive margins in men undergoing RALP for clinically localized prostate cancer. No significant financial relationships to disclose.

Planned nerve preservation modifications to reduce positive surgical margins during robotic-assisted laparoscopic radical prostatectomy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15599-15599
Author(s):  
K. Zorn ◽  
O. N. Gofrit ◽  
S. Lin ◽  
G. D. Steinberg ◽  
G. Zagaja ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Gleason Score ◽  
Clinical Stage ◽  
Laparoscopic Radical Prostatectomy ◽  
Wide Resection ◽  
Control Group ◽  
Positive Surgical Margin ◽  
Robotic Assisted ◽  
Nerve Preservation ◽  
Biopsy Gleason Score

15599 Background: Robotic-assisted laparoscopic radical prostatectomy (RLRP) is increasingly being utilized for the treatment of localized prostate cancer at many centers. The main objective of RLRP is cancer control and preservation of erectile function with reduced positive surgical margin (PSM) rates. We evaluated the effect of a side-specific nerve preservation (NP)protocol which was implemented in June 2006 to help further reduce PSM rates. Methods: Between June-November 2006, 150 consecutive RLRPs were performed using select ipsilateral, NP techniques (interfascial, extrafascial and wide resection) based on pre-operative risk factors (clinical stage, biopsy Gleason score (GS), percentage of core number positive and maximal core cancer percentage). Prior to June 2006, only interfascial and wide resection were performed. The NP protocol, included ipsilateral extrafascial dissection in all patients with GS=7 with non-palpable disease. All patients with GS≤6, non-palpable disease and whose biopsy pathology demonstrated <33% of ipsilateral cores positive for cancer were offered interfascial dissection. Wide resection was performed for patients with palpable disease, GS≥8 and ≥66% of all ipsilateral biopsy cores positive for cancer. Pathological outcomes were compared with the 245 consecutive RLRP cases performed prior to June 2006, where more liberal interfascial NP was performed. Results: Relative to the modified NP group, mean patient age (60 vs 59, p= 0.21), PSA (6.7 vs 6.8, p=0.77), clinical stage (p=0.93), biopsy Gleason score (p=0.51), pathologic Gleason score (p=0.32) and stage (p=0.65) were similar to the control group. Mean total number of positive cores involved with cancer were also comparable between groups (3.5 vs 3.3, p=0.31). Overall PSM rate was significantly lower in the modified NP group (12.6% vs 20.4%,p=0.04). Specific pT2-PSM rates were significantly lower (8.3% vs 15%, p=0.04) while only a trend was observed for pT3-PSM rates (34.5% vs 40.4%, p=0.60) in the modified NP group. Conclusions: Modifying ipsilateral nerve preservation for patients undergoing RLRP, based on specific pre-operative variables has significantly helped further reduce overall and pT2-specific PSM rates. No significant financial relationships to disclose.

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