Risk-Adjusted Analysis Of Positive Surgical Margins Following Laparoscopic And Retropubic Radical Prostatectomy

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Men's health;  Clinical Trials / Drug Trials
Article Date: 20 Jan 2008 - 0:00 PDT

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UroToday.com- Outcomes from centers of excellence serve as benchmarks for surgical procedures. In a report from Memorial Sloan Kettering Cancer Center, the positive surgical margin rates for laparoscopic radical prostatectomy (LRP) were comparable to open radical prostatectomy (ORP). The findings appear in the October issue of European Urology.

A total of 1,177 patients undergoing surgery between 2004 and 2005 comprised the study cohort. LRP was performed in 485 men by two surgeons and ORP was performed in 692 patients by two surgeons. Preoperative clinical and demographic variables and postoperative pathologic outcomes were assessed.

All prostate biopsies were reviewed by genitourinary pathologist. The ORP group had slightly higher risk disease with a statistical significant difference in preoperative probability of non-organ confined disease. Neurovascular bundle preservation as determined post-operatively was 89% in the LRP patients and 91% in the ORP patients.

The overall positive surgical margin rate was 11.0% for ORP and 11.3% after LRP. The positive surgical margin rates were 8.2% for pT2 and 17.2% for pT3 in the LRP patients and 5.3% for pT2 and 22% for pT3 in the ORP patients. The positive surgical margin rate was did not differ among the different surgeons in the LRP and ORP groups. While the positive surgical margin rate did not differ over time for ORP it did significantly decrease over time for LRP suggesting a learning curve or technical modifications.

Touijer K, Kuroiwa K, Eastham JA, Vickers A, Reuter VE, Scardino PT, Guillonneau B

Eur Urol. 52(4): 1090- 1096, October 2007
doi:10.1016/j.eururo.2006.12.014

Reported by Contributing Editor Christopher P. Evans, M.D

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