The aim of our study is to evaluate the status of positive margins (PSMs) comparing their incidence between aparoscopic radical prostatectomy (LRP) and robot assisted radical prostatectomy (RARP) in centers with medium case-load (50–150 cases/year). We also analyzed the correlations between surgical technique, nerve-sparing approach (NS), and incidence of PSMs, stratifying our results by pathological stage.
Materials and methods
We analyzed 1992 patients who underwent RP in various urologic centers. We evaluated the incidence of PSMs, and then we compared the stage-related incidence of PSMs, for both the techniques.
Results
We did not find a statistically significant difference between the two surgical modalities in the study regarding the overall incidence of PSMs.
Conclusions
In our retrospective study, we did not find any difference in terms of PSMs in RARP versus LRP. Our PSMs were not negligible, particularly in pT3 stages, compared with high-volume centers; surgical experience and patients' selection can be a possible explanation.
JemalA., BrayF., CenterM.M., FerlayJ., WardE., FormanD.. Global cancer statistics.CA Cancer J Clin.2011; 61(2): 69–90.
2.
HeidenreichA., BastianP.J., BellmuntJ.European Association of Urology. EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013.Eur Urol.2014; 65(1): 124–137.
GuillonneauB., el-FettouhH., BaumertH.Laparoscopic radical prostatectomy: oncological evaluation after 1,000 cases a Montsouris Institute.J Urol.2003; 169(4): 1261–1266.
6.
RassweilerJ., SchulzeM., TeberD.Laparoscopic radical prostatectomy with the Heilbronn technique: oncological results in the first 500 patients.J Urol.2005; 173(3): 761–764.
7.
NovaraG., FicarraV., MocellinS.Systematic review and meta-analysis of studies reporting oncologic outcome after robot-assisted radical prostatectomy.Eur Urol.2012; 62(3): 382–404.
8.
FicarraV., NovaraG., AhleringT.E.Systematic review and meta-analysis of studies reporting potency rates after robot-assisted radical prostatectomy.Eur Urol.2012; 62: 418.
9.
FicarraV., NovaraG., RosenR.C.Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy.Eur Urol.2012; 62(3): 405–417.
10.
WiederJ.A., SolowayM.S.. Incidence, etiology, location, prevention and treatment of positive surgical margins after radical prostatectomy for prostate cancer.J Urol.1998; 160(2): 299–315.
11.
KupelianP.A., KatcherJ., LevinH.S., KleinE.A.. Stage T1–2 prostate cancer: a multivariate analysis of factors affecting biochemical and clinical failures after radical prostatectomy.Int J Radiat Oncol Biol Phys.1997; 37(5): 1043–1052.
12.
ColletteL., van PoppelH., BollaM.European Organisation for Research and Treatment of Cancer (EORTC) Radiotherapy and Genito-urinary Groups. Patients at high risk of progression after radical prostatectomy: do they all benefit from immediate post-operative irradiation? (EORTC trial 22911).Eur J Cancer.2005; 41(17): 2662–2672.
13.
BollaM., van PoppelH., TombalB.European Organisation for Research and Treatment of Cancer, Radiation Oncology and Genito-Urinary Groups. Postoperative radiotherapy after radical prostatectomy for high-risk prostate cancer: long-term results of a randomised controlled trial (EORTC trial 22911).Lancet.2012; 380(9858): 2018–2027.
14.
ThompsonI.M., TangenC.M., ParadeloJ.Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: long-term follow-up of a randomized clinical trial.J Urol.2009; 181(3): 956–962.
15.
RuizL., SalomonL., HoznekA.Comparison of early oncologic results of laparoscopic radical prostatectomy by extraperitoneal vs transperitoneal approach.Eur Urol.2004; 46(1): 50–54, discussion 54–56.
16.
VeseyS.G., McCabeJ.E., HounsomeL., FowlerS.. UK radical prostatectomy outcomes and surgeon case volume: based on an analysis of the British Association of Urological Surgeons Complex Operations Database.BJU Int.2012; 109(3), 346–354.
17.
VickersA., BiancoF., CroninA.The learning curve for surgical margins after open radical prostatectomy: implications for margin status as an oncological end point.J Urol.2010; 183(4): 1360–1365.
18.
SecinF.P., SavageC., AbbouC.The learning curve for laparoscopic radical prostatectomy: an international multicenter study.J Urol.2010; 184(6): 2291–2296.
19.
SooriakumaranP., JohnM., WiklundP., LeeD., NilssonA., TewariA.K.. Learning curve for robotic assisted laparoscopic prostatectomy: a multi-institutional study of 3794 patients.Minerva Urol Nefrol.2011; 63(3): 191–198.
20.
TewariA., SooriakumaranP., BlochD.A., Seshadri-KreadenU., HebertA.E., WiklundP.. Positive surgical margin and perioperative complication rates of primary surgical treatments for prostate cancer: a systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy.Eur Urol.2012; 62(1): 1–15.
21.
CoelhoR.F., RoccoB., PatelM.B.Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a critical review of outcomes reported by high-volume centers.J Endourol.2010; 24(12): 2003–2015.
22.
HowladerN., NooneA.M., KrapchoM.SEER Cancer Statistics Review, 1975–2009 (Vintage 2009 Populations), National Cancer Institute. Bethesda, MD.http://seer.cancer.gov/csr/1975_2009_pops09/
23.
ChengL., SlezakJ., BergstralhE.J., MyersR.P., ZinckeH., BostwickD.G.. Preoperative prediction of surgical margin status in patients with prostate cancer treated by radical prostatectomy.J Clin Oncol.2000; 18(15): 2862–2868.
24.
WardJ.F., ZinckeH., BergstralhE.J., SlezakJ.M., MyersR.P., BluteM.L.. The impact of surgical approach (nerve bundle preservation versus wide local excision) on surgical margins and biochemical recurrence following radical prostatectomy.J Urol.2004; 172(4 Pt 1): 1328–1332.
25.
SoferM., Hamilton-NelsonK.L., SchlesselmanJ.J., SolowayM.S.. Risk of positive margins and biochemical recurrence in relation to nerve-sparing radical prostatectomy.J Clin Oncol.2002; 20(7): 1853–1858.
26.
AckermanD.A., BarryJ.M., WicklundR.A., OlsonN., LoweB.A.. Analysis of risk factors associated with prostate cancer extension to the surgical margin and pelvic node metastasis at radical prostatectomy.J Urol.1993; 150(6): 1845–1850.
27.
PatelV.R., CoelhoR.F., RoccoB.Positive surgical margins after robotic assisted radical prostatectomy: a multi-institutional study.J Urol.2011; 186(2): 511–516.
28.
LissM., OsannK., OrnsteinD.. Positive surgical margins during robotic radical prostatectomy: a contemporary analysis of risk factors.BJU Int.2008; 102(5): 603–608.
