Positive Surgical Margins During Robotic Radical Prostatectomy: A Contemporary Analysis Of Risk Factors

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology
Article Date: 02 Jul 2008 - 1:00 PDT

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UroToday.com - In the online version of the BJU International, Dr. Liss and colleagues assess the risk factors associated with a positive surgical margin (PSM) that can occur during robotic radical prostatectomy (RARP).

Between 2003 and 2007, 216 consecutive patients underwent RARP by one surgeon. Clinical and pathologic characteristics were assessed in univariate and multivariate analysis. A PSM was defined as the presence of ink on prostate cancer cells in the primary specimens. In the fist 82 men, the dorsal venous complex (DVC) was controlled with a stapler and in the next 134 cases it was suture ligated.

The overall PSM rate was 14.8%, similar to contemporary open or laparoscopic series. After adjusting for pathological stage, men older than 70 years had a lower rate of PSM. The PSM rate also increased with increasing PSA levels; from an age-adjusted odds ratios of 2 for PSA <6 compared to 16.2 for a PSA level >10ng/ml. The overall and pT2 PSM rate remained constant throughout the patient series; although a small effect was noted in the multivariate analysis. When the suturing technique was used to secure the DVC, there was a learning curve noted in pT3 tumors with a significant decrease in PSM over time. In pT2 tumors, there was no difference in PSM for men who had nerve-sparing vs. non-nerve sparing. However, in multivariable analysis, nerve-sparing was associated with a significant increase in PSM after adjusting for stage, age and pathological Gleason score. Stage pT3 tumors had a higher PSM that pT2 tumors (unadjusted OR 9.5) and pathological stage was the most important predictor of PSM.

Interestingly, the learning curve for this surgeon regarding PSM was less severe that the surgeon who established the robotics program at their institution. This suggests that once a robotics program is established, the learning curve for subsequent surgeons will benefit from the program in place.

Liss M, Osann K, Ornstein D
BJU Int. 2008 Apr 24. Epub ahead of print.
doi:10.1111/j.1464-410X.2008.07672.x

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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