A Comparison of the Incidence and Location of Positive Surgical Margins in Robotic Assisted Laparoscopic Radical Prostatectomy and Open Retropubic Radical Prostatectomy

Vanderbilt University, Нашвилл, Michigan, United States
The Journal of urology (Impact Factor: 4.47). 12/2007; 178(6):2385-9; discussion 2389-90. DOI: 10.1016/j.juro.2007.08.008
Source: PubMed


Surgical technique, patient characteristics and method of pathological review may influence surgical margin status. We evaluated the incidence and location of positive surgical margins in 200 sequential robotic assisted laparoscopic radical prostatectomy and 200 sequential open radical retropubic prostatectomy cases.
From July 2002 until December 2006 a total of 1,747 patients underwent radical prostatectomy at our institution (robotic assisted laparoscopic radical prostatectomy in 1,238, radical retropubic prostatectomy in 509). From these we selected the last 200 consecutive radical retropubic prostatectomies and 200 robotic assisted laparoscopic radical prostatectomies performed before August 2006. Preoperative clinical characteristics including age, clinical stage, prostate specific antigen and Gleason score were evaluated. Postoperatively pathological specimens were assessed for specimen weight, Gleason score, tumor volume, pathological stage and margin status. The incidence and location of positive surgical margins were compared between robotic assisted laparoscopic radical prostatectomy and radical retropubic prostatectomy.
Patients undergoing robotic assisted laparoscopic radical prostatectomy compared to radical retropubic prostatectomy had more favorable tumor characteristics including lower prostate specific antigen, clinical stage and Gleason score. No statistically significant differences were found between groups for prostate volume or tumor volume. However, tumor volume as a percentage of prostate volume was higher among radical retropubic prostatectomy compared to robotic assisted laparoscopic radical prostatectomy cases (17.7% vs 13%, p = 0.001). The overall incidence of positive surgical margins was significantly lower among the robotic assisted laparoscopic radical prostatectomy compared to radical retropubic prostatectomy cases (15% vs 35%, p <0.001). The incidence of positive surgical margins according to pathological stage for robotic assisted laparoscopic radical prostatectomy vs radical retropubic prostatectomy cases was 16 of 171 (9.4%) vs 33 of 137 (24.1%) for pT2 (p <0.001) and 14 of 28 (50%) vs 36 of 60 (60%) for pT3. In both groups the apex was the most common site of positive surgical margins with 52% in the robotic assisted laparoscopic radical prostatectomy group vs 37% in the radical retropubic prostatectomy group (p >0.05).
In the hands of surgeons experienced in robotic assisted laparoscopic radical prostatectomy and radical retropubic prostatectomy, there was a statistically significant lower positive margin rate for patients undergoing robotic assisted laparoscopic radical prostatectomy. The most common location of a positive surgical margin in robotic assisted laparoscopic radical prostatectomy and radical retropubic prostatectomy cases was at the apex. Patients treated with radical retropubic prostatectomy had higher risk features which may have independently influenced these results. The method of pathological specimen analysis and reporting may account for the higher positive margin rates in both groups compared to some reports.

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    • "Robot-assisted laparoscopic prostatectomy (RALP) has become a common treatment option for patients with localized prostate cancer [1]. Comparisons of open radical retropubic prostatectomy with RALP have demonstrated that these procedures have nearly equivalent oncological outcomes and similar rates of complications relating to continence and erectile function [2]. "
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    ABSTRACT: To determine the effect of prostate weight on the preoperative and postoperative outcomes of robotic-assisted laparoscopic radical prostatectomy with a posterior approach to the seminal vesicle. This retrospective study examined prospectively collected data on 219 robotic-assisted laparoscopic radical prostatectomies performed from May 2011 to February 2013. Patients were divided into four groups based on pathologic prostate weight: <30 g, 30-49 g, 50-79 g, and >=80 g. Continence and sexual function were assessed using validated questionnaires. Of the 219 patients, 19, 143, 51, and 6 had prostates weighing <30 g, 30-49 g, 50-79 g, and >=80 g, respectively. Significant differences were found between the preoperative Gleason scores, total operative times, and robotic times of the groups. Both estimated blood loss and anastomosis time tended to be greater in the higher prostate weight groups, but the differences were not significant. No significant differences were observed in transfusion rate, length of catheterization, complication incidence, or positive surgical margins. The return of urinary function, as determined by questionnaire scores, was not affected by prostate weight. Robotic-assisted laparoscopic radical prostatectomy can be performed safely and with similar perioperative outcomes, regardless of prostate weight. Indeed, oncological outcome, urinary continence, and complications were similar across the prostate weight groups, suggesting that robotic-assisted laparoscopic radical prostatectomy with a posterior approach to the seminal vesicle may be performed effectively on men with large prostates, despite greater surgical times.
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    • "In most studies, NVB sparing had no significant impact on PSMs [11-15]. Nonetheless, in several robotic prostatectomy series, increased PSM rates in pathological T3 tumors were found to be related to nerve sparing [16-19]. "
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    Full-text · Article · Dec 2013 · Korean journal of urology
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    • "A large population-based study of 4240 patients found similar PSM rates for all three approaches (20.1% for open RP, 17.4% for laparoscopic RP, and 17.4% for robotic RP) [10], whereas other investigators have found significant differences in outcome by surgical approach. For example, two recent studies showed lower PSM rates after robotic RP compared with open RP [11] [12], although another report demonstrated the converse [9]. Part of the reason for the conflicting findings is that many reports involve only small numbers of patients and do not adequately adjust for differences among surgical cohorts that can affect the outcome of interest (PSM). "
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