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.

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.

Modified clipless antegrade nerve preservation in robotic-assisted laparoscopic radical prostatectomy with validated sexual function evaluation

Urology ◽  
2005 ◽  
Vol 66 (2) ◽  
pp. 419-423 ◽  
Author(s):  
Gary W. Chien ◽  
Albert A. Mikhail ◽  
Marcelo A. Orvieto ◽  
Gregory P. Zagaja ◽  
Mitchell H. Sokoloff ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Sexual Function ◽  
Laparoscopic Radical Prostatectomy ◽  
Function Evaluation ◽  
Robotic Assisted ◽  
Nerve Preservation

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

Prostate weight as an independent predictor for both extracapsular extension and positive surgical margins during robotic- assisted laparoscopic radical prostatectomy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15608-15608
Author(s):  
L. Msezane ◽  
K. C. Zorn ◽  
O. N. Gofrit ◽  
G. D. Steinberg ◽  
G. P. Zagaja ◽  
...  
Keyword(s):  
Gleason Score ◽  
Independent Predictor ◽  
Clinical Stage ◽  
Multivariate Logistic Regression Analysis ◽  
Pathological Stage ◽  
Multivariate Logistic Regression ◽  
Extracapsular Extension ◽  
Robotic Assisted ◽  
Prostate Weight ◽  
Biopsy Gleason Score

15608 Background: Pre-operative prediction of pathological stage represents the cornerstone of prostate cancer management. Patient counseling is routinely based on pre-operative PSA, Gleason score and clinical stage. In this study, we evaluated whether prostate weight (PW) is an independent predictor of extracapsular extension (ECE) and positive surgical margin (PSM). Methods: Between February 2003 and November 2006, 709 men underwent robotic-assisted laparoscopic radical prostatectomy (RLRP). Pre-operative parameters (patient age, pre-operative PSA, biopsy Gleason score, clinical stage) as well as pathological data (prostate weight, pathological stage) were prospectively gathered after IRB approval. Evaluation of the influence of these variables on ECE and PSM outcomes were assessed using both univariate and multivariate logistic regression analysis. Results: Mean overall patient age, pre-operative PSA and PW were 59.6 years, 6.5ng/ml and 52.9g (range 5.5–198.7g), respectively. Of the 393, 209 and 107 men with PW <50g, 50-<70g and >70g, ECE was observed in 20.1%, 15.3% and 9.3%, respectively (p=0.015). In the same patient cohorts, PSM was observed in 25.4%, 14.4% and 7.5%, respectively (p<0.001). In a multivariate logistic regression analysis, PW, in addition to pre-operative PSA, biopsy Gleason score and clinical stage, was an independent risk factor for ECE (p<0.001). Similarly, in multi-variate analysis, PW was observed to be a risk factor for PSM (p<0.001). Conclusions: PW is an independent predictor of both ECE and PSM, with an inverse relationship having been demonstrated between both variables. PW should be considered when counseling patients with prostate cancer treatment. No significant financial relationships to disclose.

scholarly journals Three-dimensional Camera Systems Assistant the Sheath of Prostate Preservation Laparoscopic Radical Prostatectomy: Technique and Initial Experience

2020 ◽  
Author(s):  
Lingmin Song ◽  
Gang Wang ◽  
Wenbo Gao ◽  
Yusheng Yang ◽  
Guobin Weng
Keyword(s):  
Radical Prostatectomy ◽  
Gleason Score ◽  
Clinical Stage ◽  
Three Dimensional ◽  
Operation Time ◽  
Laparoscopic Radical Prostatectomy ◽  
Resection Margins ◽  
Estimated Blood Loss ◽  
The Mean

Abstract Background: To report our refinement of laparoscopic radical prostatectomy by preservation of the sheath of prostate (SPP-LRP) and 1-year follow-up results.Methods: SPP-LRP was performed in 39 consecutive patients diagnosed as clinically localized prostate cancer from January 2016 to December 2018. The inclusion criteria consisted of Gleason score ≤7, tPSA＜10 ng/ml, positive in no more than 3 in 12 needles by systematical puncture biopsy, less than 50% tumor core involvement, clinical stage T1-2, good potency. The oncological results were identified by postoperative pathology test. Functional outcomes, including continence and potency, were followed postoperatively.Results: The mean operation time was 108.3±35.2 min and the mean estimated blood loss was 129.3±46.4 ml with no transfusion. The catheter was removed 7 days after the surgery. There were no relevant postoperative complications requiring intervention. The histopathological results showed 2 cases (6.1%) in pT2 and 1 case (16.7%) in pT3 presented positive resection margins for tumor (R1). Only 1 case (pT3a,Gleason score 8) suffered pelvic lymph node metastasis. No biochemical relapse was observed after 1-year follow-up. The continence rates were 71.8% and 87.2% after 1 and 3 months, and no patients suffered G2 incontinence after 6 months , and 97.4% recovered continence after 12 months. The potency rates were 61.5% and 82.1% after 1 and 3 months, and that was 92.3% after 12 months. Conclusion:SPP-LRP is a practical and worth-promoting technique for RP. The initial results are preferable and promising in technical, oncological and functional aspects.

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