Incidence and location of positive surgical margin among open, laparoscopic and robot-assisted radical prostatectomy in prostate cancer patients: a single institutional analysis

To present own initial experience of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) and surgical technique. In OctoberNovember 2019 on the basis of the Urological Department and the Center for Robotic Surgery of City Mariinsky Hospital (Saint Petersburg, Russia) five patients with localized prostate cancer were treated with RS-RARP. The operation time was from 140 to 205 min. The blood loss volume was from 50 to 250 ml. No conversions and intraoperative complications were recorded. Nervous-saving RS-RARP was performed in three patients. No blood transfusions were performed. Two patients faced Clavien Grade I postoperative complications. Immediate continence after removal of the urethral catheter was noted in 3 out of 5 patients. All the patients became continent for 2 weeks. One extraprostatic positive surgical margin was recorded. RS-RARPis an accessible technique for treating patients with localized prostate cancer, which allows achieving high early results. It is necessary to accumulate more experience of such surgeries to assess the distant outcomes and compare them with the data of the robot-assisted radical prostatectomies performed by other approaches.

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Correlation of biologic recurrence after radical prostatectomy and a positive surgical margin with the predominant Gleason pattern on the specimen.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e15145 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e15145-e15145

Author(s):

Yann Neuzillet ◽

Audrey Pichon ◽

Thierry Lebret ◽

Jean-Pierre Raynaud ◽

Henry Botto

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Cancer Patients ◽

Surgical Margin ◽

Surgical Margins ◽

Rank Test ◽

Multivariate Logistic Regression Model ◽

Positive Surgical Margin ◽

Positive Surgical Margins ◽

Gleason Pattern

e15145 Background: The risk of biological recurrence following radical prostatectomy depends, among other factors, on surgical margins status. This study compared the prognosis of prostate cancer patients with positive surgical margins according to the predominant Gleason pattern (PrdGP). Methods: Prospective study of 247 consecutive prostate cancer patients, who underwent radical prostatectomy (RP) from 3/2007 to 12/2009, and were followed up in our institution. Pathological stage and Gleason score were determined in RP specimens by a pathological reference. Biological recurrence was defined as two consecutive values of PSA > 0.2 ng/mL. The median overall follow-up was 33 months (2 to 54 months). Biological recurrence-free survival was estimated and compared using Kaplan-Meier plots and Log rank test. A multivariate logistic regression model was done with PrdGP4, and two other predictive variables (pT≥3a, preoperative PSA level) entered as statistically significant independent predictors of biological recurrence. Results: Forty-eight patients (19.4%) had a positive surgical margins, 26 patients have PrdGP3 (54%) and 22 have PrdGP4 (46%). Whereas 7 biological recurrences were observed in PrdGP4 patients, none occurred in PrdGP3 patients. Biological recurrence-free survivals were significantly different (Log rank p=0.001). In multivariate analysis, PrdGP4 was a predictor of biological recurrence (p<0.0001, OR= 9.023, 95% CI [3.161–25.757]). Conclusions: This study demonstrates that biological recurrence after positive surgical margin are correlated with the predominant Gleason pattern assessed on radical prostatectomy specimen which s more easily evaluable than accurate margins features. Adjuvant treatment, specifically external beam radiotherapy, should be indicated in accordance to this result. [Table: see text]

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Comparison of positive surgical margin rates in prostate cancer: Open versus robot assisted laparoscopic radical prostatectomy

European Urology Supplements ◽

10.1016/s1569-9056(16)30399-2 ◽

2016 ◽

Vol 15 (13) ◽

pp. e1586-e1587

Author(s):

J. Park ◽

S.Y. Cho ◽

M.C. Cho ◽

H. Jeong

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Surgical Margin ◽

Laparoscopic Radical Prostatectomy ◽

Positive Surgical Margin ◽

Robot Assisted ◽

Open Versus

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Oncologic outcomes in prostate cancer patients treated with robot-assisted radical prostatectomy: results from a single institution series with more than 10 years follow up

Minerva Urologica e Nefrologica ◽

10.23736/s0393-2249.18.03285-x ◽

2019 ◽

Vol 71 (1) ◽

Cited By ~ 6

Author(s):

Lorenzo Bianchi ◽

Giorgio Gandaglia ◽

Nicola Fossati ◽

Alessandro Larcher ◽

Cristian Pultrone ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Cancer Patients ◽

Oncologic Outcomes ◽

Single Institution ◽

Robot Assisted

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Prediction of a positive surgical margin and biochemical recurrence after robot-assisted radical prostatectomy

Scientific Reports ◽

10.1038/s41598-021-93860-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ching-Wei Yang ◽

Hsiao-Hsien Wang ◽

Mohamed Fayez Hassouna ◽

Manish Chand ◽

William J. S. Huang ◽

...

Keyword(s):

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Multivariable Analysis ◽

Specific Antigen ◽

Surgical Margin ◽

Asian Population ◽

Nerve Sparing ◽

Positive Surgical Margin ◽

Robot Assisted ◽

Surgeon Experience

AbstractThe positive surgical margin (PSM) and biochemical recurrence (BCR) are two main factors associated with poor oncotherapeutic outcomes after prostatectomy. This is an Asian population study based on a single-surgeon experience to deeply investigate the predictors for PSM and BCR. We retrospectively included 419 robot-assisted radical prostatectomy cases. The number of PSM cases was 126 (30.1%), stratified as 22 (12.2%) in stage T2 and 103 (43.6%) in stage T3. Preoperative prostate-specific antigen (PSA) > 10 ng/mL (p = 0.047; odds ratio [OR] 1.712), intraoperative blood loss > 200 mL (p = 0.006; OR 4.01), and postoperative pT3 stage (p < 0.001; OR 6.901) were three independent predictors for PSM while PSA > 10 ng/mL (p < 0.015; hazard ratio [HR] 1.8), pT3 stage (p = 0.012; HR 2.264), International Society of Urological Pathology (ISUP) grade > 3 (p = 0.02; HR 1.964), and PSM (p = 0.027; HR 1.725) were four significant predictors for BCR in multivariable analysis. PSMs occurred mostly in the posterolateral regions (73.8%) which were associated with nerve-sparing procedures (p = 0.012) while apical PSMs were correlated intraoperative bleeding (p < 0.001). A high ratio of pT3 stage after RARP in our Asian population-based might surpass the influence of PSM on BCR. PSM was less significant than PSA and ISUP grade for predicting PSA recurrence in pT3 disease. Among PSM cases, unifocal and multifocal positive margins had a similar ratio of the BCR rate (p = 0.172) but ISUP grade > 3 (p = 0.002; HR 2.689) was a significant BCR predictor. These results indicate that PSA and pathological status are key factors influencing PSM and BCR.

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