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.

Obesity and metabolic syndrome correlate with a higher risk of biochemical recurrence in high risk and intermediate risk prostate cancer patients who underwent robotic-assisted laparoscopic prostatectomy.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 5580-5580
Author(s):  
Shifeng Mao ◽  
Ralph Miller ◽  
John Lyne ◽  
Jeffrey Cohen ◽  
Arash Samiei
Keyword(s):  
Prostate Cancer ◽  
Metabolic Syndrome ◽  
Biochemical Recurrence ◽  
Surgical Margin ◽  
Positive Surgical Margin ◽  
Obese Patients ◽  
Robotic Assisted ◽  
Laparoscopic Prostatectomy ◽  
Increased Risk ◽  
Significant Difference

5580 Background: Obesity and metabolic syndrome (MS) is prevalent in our society, and have been linked to a higher incidence of prostate cancer (PCa). The relationship of obesity or MS and cancer control has yielded mixed results in previous studies. We examined the correlation between the incidence of biochemical recurrence (BCR) with MS and BMI in a cohort of patients with PCa who underwent robotic-assisted laparoscopic prostatectomy (RALP). Methods: A retrospective study of patients who underwent RALP at a single center from 2007 to 2015 was conducted. Parameters including preoperative BMI, fasting glucose, lipid profile, blood pressure, PSA, Gleason score, pathologic stage, time to BCR, and surgical margin status were analyzed. Patients were categorized in high (HR), intermediate (IR), and low-risk (LR) groups based on the National Comprehensive Cancer Network (NCCN) guidelines. WHO classification was used for MS criteria, and BCR was defined as two consecutive postoperative PSA volume of ≥ 0.2 ng/mL. Obesity is defined as BMI ≥30 kg/m2. Results: A total of 726 patients with 189 in HR, 471 in IR and 66 patients in LR groups were included in this study with the median age of 59 (interquartile range [IQR] 55-64) years old. The median follow-up from surgery was 38 (IQR 22-46) months. More obese patients were found in the HR group compared to IR/LR group (46.5% vs. 33.1%, p<0.01). There were also more patients with MS in the HR group compared to IR/LR group (36.5% vs. 12.0%, p<0.01). Obese patients had a higher rate of BCR across risk groups in comparison to non-obese patients 32.1% vs. 15.4% (P<0.001), specifically 68% vs. 40%(p<0.01) in HR group and 21.3% vs. 12.7% (p=0.035) in the IR group. Similarly, patients with MS had a higher rate of BCR in HR and IR groups in comparison to the patients without MS, 39.1% vs. 18.7% (P<0.01); specifically, 67.7% vs. 42.2% (p<0.01) in HR and 29% vs. 11.6% (p<0.01) in the IR group. No correlation between MS or obesity and BCR was observed in LR group. There was no statistically significant difference in the positive surgical margin rate between obese and non-obese cohorts in each risk group. Conclusions: Among HR and IR-PCa patietns who underwent RALP, both obesity and MS correlate with increased risk of BCR. There were significantly more obesity and MS in HR-PCa patients, suggesting a potential pathophysiologic interplay between obesity or MS and cancer progression.

Radical Retropubic Prostatectomy and Robotic-assisted Laparoscopic Prostatectomy: Likelihood of Positive Surgical Margin(s)

Urology ◽  
2010 ◽  
Vol 76 (5) ◽  
pp. 1097-1101 ◽  
Author(s):  
Stephen B. Williams ◽  
Ming-Hui Chen ◽  
Anthony V. D'Amico ◽  
Aaron C. Weinberg ◽  
Ravi Kacker ◽  
...  
Keyword(s):  
Surgical Margin ◽  
Radical Retropubic Prostatectomy ◽  
Positive Surgical Margin ◽  
Robotic Assisted ◽  
Laparoscopic Prostatectomy ◽  
Retropubic Prostatectomy

Clinical predictors for biochemical failure in patients with positive surgical margin after robotic-assisted radical prostatectomy

2021 ◽  
pp. 030089162110079
Author(s):  
Shih-Huan Su ◽  
Ying-Hsu Chang ◽  
Liang-Kang Huang ◽  
Yuan-Cheng Chu ◽  
Hung-Cheng Kan ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Cox Regression ◽  
Specific Antigen ◽  
Surgical Margin ◽  
Biochemical Failure ◽  
Positive Surgical Margin ◽  
Cox Regression Analysis ◽  
Robotic Assisted ◽  
Robotic Assisted Radical Prostatectomy

Objective: Patients with positive surgical margins (PSMs) after radical prostatectomy for localized prostate cancer have a higher risk of biochemical failure (BCF). We investigated the risk factors of BCF in patients with PSMs after robotic-assisted radical prostatectomy (RARP). Methods: We evaluated 462 patients who underwent RARP in a single medical center from 2006 through 2013. Of them, 61 with PSMs did not receive any treatment before BCF. Kaplan-Meier curve and Cox regression analysis were used to compare patients with (n = 19) and without (n = 41) BCF. Results: Overall, 13.2% of patients had PSMs, and of those, 31.7% experienced BCF during follow-up. The mean follow-up duration was 43.7 months (42.4 [non-BCF] vs 46.35 (BCF], p = 0.51). In univariant analyses, the platelet to lymphocyte ratio (6.26 [non-BCF] vs 8.02 [BCF], p = 0.04) differed statistically. When patients were grouped by pathologic grade ≦2 or ≧3 ( p = 0.004), the BCF-free survival rates differed significantly. Seminal vesicle invasion also differed significantly (5 [non-BCF] vs 7 [BCF], p = 0.005). Patients with undetectable nadir prostate-specific antigen (PSA) after RARP (BCF rate 4/34) differed statistically from those with detectable PSA after RARP (BCF rate 15/26) ( p < 0.001). In the multivariate analysis, the platelet/lymphocyte (P/L) ratio, pathologic grade, and undetectable nadir PSA remained statistically significant. Conclusions: In patients who undergo RARP and have PSMs, P/L ratio >9 preoperatively, pathologic grade ⩾3, and detectable nadir PSA after RARP should be considered adverse features. Early intervention such as salvage radiation therapy or androgen deprivation therapy should be offered to these patients.

IMPACT OF PROSTATE VOLUME ON SURGICAL MARGIN RATES IN ROBOTIC-ASSISTED LAPAROSCOPIC PROSTATECTOMY

2009 ◽  
Vol 181 (4S) ◽  
pp. 760-760
Author(s):  
Nishant D Patel ◽  
Philip J Dorsey ◽  
Robert A Leung ◽  
Gerald Y Tan ◽  
Jay K Jhaveri ◽  
...  
Keyword(s):  
Prostate Volume ◽  
Surgical Margin ◽  
Robotic Assisted ◽  
Laparoscopic Prostatectomy

Predictors of outcome after primary flexor tendon repair in zone 1, 2 and 3

2016 ◽  
Vol 41 (8) ◽  
pp. 793-801 ◽  
Author(s):  
I. Z. Rigo ◽  
M. Røkkum
Keyword(s):  
Flexor Tendon ◽  
Linear Regression Analysis ◽  
Tendon Repair ◽  
Tendon Sheath ◽  
Multiple Linear Regression Analysis ◽  
Level Of Evidence ◽  
Pulley System ◽  
Skeletal Injury ◽  
Active Mobilization

We retrospectively reviewed the outcomes of flexor tendon repairs in zones 1, 2 and 3 in 356 fingers in 291 patients between 2005 and 2010. The mean (standard deviation) active ranges of motion of two interphalangeal joints of the fingers were 98° (40) and 114° (45) at 8 weeks postoperatively and at the last follow-up (mean 7 months, range 3–98), respectively. Using the Strickland criteria, ‘excellent’ or ‘good’ function was obtained in 95 (30%) out of 322 fingers at 8 weeks and 107 (48%) out of 225 fingers at the last follow-up. A total of 48 (13%) fingers required reoperation because of rupture, adhesion, contracture or other complications. The prevalence of rupture was 4%. We carried out multiple linear regression analysis to identify the predictors of the active digital motion. The following variables were found as negative predictors: age; smoking; injury localization between subzones 1C and 2C; injury to the little finger; the extent of soft tissue damage; concomitant skeletal injury; delay to surgery; use of a 2-strand Kessler repair technique; attempted suture or preservation of the tendon sheath–pulley system; and resecting or leaving the concomitant superficial flexor tendon cuts untreated. Analysing the 8 weeks results of tendon repairs in zones 1 and 2, early active mobilization was found to be superior to Kleinert’s regime. Level of evidence: III

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