Population-based comparison of surgical margin status for robotic versus open radical prostatectomy.

51 Background: Robotic-assisted radical prostatectomy (RARP) remains controversial due to exaggerated marketing claims, higher costs, hidden risks, and few clinically significant benefits, including an absence of improved cancer control compared to open radical prostatectomy (ORP). The purpose of our study is to compare surgical margin status by surgical approach. Methods: We identified 13,434 men with a histologically confirmed, non-metastatic prostate cancer treated with RARP versus ORP during 2004 and 2009 from Surveillance, Epidemiology, and End Results (SEER)–Medicare linked data. Propensity-based analyses were performed to minimize treatment selection biases. Generalized linear regression models were computed for comparison of radical prostatectomy surgical margin status by surgical approach. Results: During the study period, 5,556 and 7,878 men underwent RARP and ORP, respectively. In the propensity-adjusted cohort, the incidence of positive surgical margins was significantly lower among men undergoing RARP versus ORP (13.7% vs. 18.4%, odds ratio [OR]: 0.68, 95% confidence interval [CI]: 0.63–0.73, p<0.001). This reduction in the incidence of positive surgical margins of RARP over ORP was more pronounced among men with more advanced disease—6.6% lower absolute incidence of positive margins among men with intermediate- and high-risk disease (p<0.001, respectively) and 15.4% lower absolute incidence of positive margins among men with extracapsular extension (p<0.001). Moreover, RARP was associated with lower odds of positive surgical margins compared to ORP for pT2 (Odds Ratio [OR] 0.67, 95% Confidence Interval [CI] 0.61–0.74, p<0.001) and pT3a (OR 0.72, 95% CI 0.60–0.85, p<0.001) disease. Additionally, RARP was associated with lower odds of positive surgical margins for intermediate (OR 0.66, 95% CI 0.58–0.74) and high-risk (OR 0.69, 95% CI 0.64–0.75) disease. Conclusions: RARP was associated with improved surgical margin status among men with intermediate and high-risk disease. This has important implications for cancer control, patient quality of life, health care delivery and additional costs of downstream therapies.

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Preoperative Prediction of Surgical Margin Status in Patients With Prostate Cancer Treated by Radical Prostatectomy

Journal of Clinical Oncology ◽

10.1200/jco.2000.18.15.2862 ◽

2000 ◽

Vol 18 (15) ◽

pp. 2862-2868 ◽

Cited By ~ 106

Author(s):

Liang Cheng ◽

Jeff Slezak ◽

Erik J. Bergstralh ◽

Robert P. Myers ◽

Horst Zincke ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Confidence Interval ◽

Odds Ratio ◽

Surgical Margin ◽

Margin Status ◽

Surgical Margins ◽

Positive Surgical Margin ◽

Biopsy Specimens ◽

Preoperative Serum

PURPOSE: We sought to determine the preoperative factors associated with surgical margin status in patients who underwent radical prostatectomy for prostate cancer. PATIENTS AND METHODS: The study group consisted of 339 patients who were treated by radical retropubic prostatectomy and bilateral pelvic lymphadenectomy at the Mayo Clinic. None received preoperative adjuvant therapy. The mean age at the time of surgery was 66 years (range, 45 to 79 years). All specimens were totally embedded and whole-mounted. Positive surgical margin was defined as the presence of cancer cells at the inked margins. Numerous pathologic characteristics in needle biopsies and preoperative clinical findings were analyzed. RESULTS: The overall margin positivity rate was 24%. In univariate analysis, preoperative serum prostate-specific antigen (PSA) level, Gleason score, perineural invasion, percentage of cancer in the biopsy specimens, and number and percentage of biopsy cores involved by cancer were all associated with positive surgical margins. In multivariate analysis, preoperative serum PSA level (odds ratio for a doubling of PSA levels, 1.9; 95% confidence interval, 1.5 to 2.4; P < .001) and percentage of cancer in the biopsy specimens (odds ratio for a 10% increase, 1.3; 95% confidence interval, 1.2 to 1.4; P < .001) were predictive of margin status in radical prostatectomy. With use of preoperative serum PSA level and percentage of cancer in the biopsy as predictors of surgical margins, the overall accuracy as measured by the area under the receiver operating characteristic curve was 0.74. CONCLUSION: Preoperative serum PSA level and percentage of cancer in the biopsy specimens were independently associated with surgical margin status in patients who underwent radical prostatectomy for prostate cancer. The combination of these two factors provides a high level of predictive accuracy for margin status.

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Re: The Learning Curve for Surgical Margins After Open Radical Prostatectomy: Implications for the Use of Margin Status as an Oncologic Endpoint

European Urology ◽

10.1016/j.eururo.2010.10.014 ◽

2011 ◽

Vol 59 (1) ◽

pp. 171-172 ◽

Cited By ~ 1

Author(s):

Anton Ponholzer ◽

Stephan Madersbacher

Keyword(s):

Radical Prostatectomy ◽

Learning Curve ◽

Margin Status ◽

Surgical Margins ◽

Open Radical Prostatectomy

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Impact of surgical margin status on long-term cancer control after radical prostatectomy

BJU International ◽

10.1111/j.1464-410x.2006.06563.x ◽

2006 ◽

Vol 98 (6) ◽

pp. 1199-1203 ◽

Cited By ~ 31

Author(s):

Marcelo A. Orvieto ◽

Nejd F. Alsikafi ◽

Arieh L. Shalhav ◽

Brett A. Laven ◽

Gary D. Steinberg ◽

...

Keyword(s):

Radical Prostatectomy ◽

Surgical Margin ◽

Cancer Control ◽

Margin Status

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Oncological outcome of neoadjuvant low-dose estramustine plus LHRH agonist/antagonist followed by extended radical prostatectomy for Japanese patients with high-risk localized prostate cancer: a prospective single-arm study

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyz138 ◽

2019 ◽

Vol 50 (1) ◽

pp. 66-72 ◽

Cited By ~ 1

Author(s):

Hideki Enokida ◽

Yasutoshi Yamada ◽

Shuichi Tatarano ◽

Hirofumi Yoshino ◽

Masaya Yonemori ◽

...

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Radical Prostatectomy ◽

Cox Regression ◽

External Beam Radiotherapy ◽

Oncological Outcome ◽

Muscle Layer ◽

Surgical Margins ◽

Positive Surgical Margins ◽

Cox Regression Analysis

Abstract Background Patients with advanced high-risk prostate cancer (PCa) are prone to have worse pathological diagnoses of positive surgical margins and/or lymph node invasion, resulting in early biochemical recurrence (BCR) despite having undergone radical prostatectomy (RP). Therefore, it is controversial whether patients with high-risk PCa should undergo RP. The purpose of this study was to evaluate the efficacy of neoadjuvant chemohormonal therapy (NAC) followed by “extended” RP. Methods A total of 87 patients with high-risk PCa prospectively underwent extended RP after NAC; most of the patients underwent 6 months of estramustine phosphate (EMP) 140 mg twice daily, along with a luteinizing hormone-releasing hormone agonist/antagonist. We developed our surgical technique to reduce the rate of positive surgical margins. We aimed to approach the muscle layer of the rectum by dissecting the mesorectal fascia and continuing the dissection through the mesorectum until the muscle layer of the rectum was exposed. Results More than 1 year had elapsed after surgery in all 86 patients, with a median follow-up period of 37.7 months. The 3-year BCR-free survival was 74.9%. Multivariate Cox-regression analysis revealed that a positive core ratio of 50% or greater and pathological stage of pT3 or greater were independent predictors for BCR. About 17 of 23 cases received salvage androgen deprivation therapy and concurrent external beam radiotherapy, and showed no progression after the salvage therapies. Conclusions NAC concordant with extended RP is feasible and might provide good cancer control for patients with high-risk PCa.

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