Charcteristics of Positive Surgical Margins in Robotic Assisted Laparoscopic Radical Prostatectomy (RobRP), Open Retropubic Radical Prostatectomy (RRP) and Laparoscopic Radical Prostatectomy (LapRP): A Comparative Study from a Single Academic Center
R Albadine, JY Jeong, F Tavora, JI Epstein, M Gonzalgo, C Pavlovich, GJ Netto. Johns Hopkins, Baltimore
Background: A positive surgical margin (SM+) is an independent predictor of PCa recurrence following prostatectomy. Reported rate of SM+ varies from 15-35% in RobRP, RRP and LapRP. Studies detailing differences in extent and location of SM+ among the 3 techniques are lacking.
Design: A retrospective blinded review of all 99 SM+ prostatectomies performed at our center during an 2007 calendar year, was conducted by two urologic pathologists. Our cohort included: 38 RobRP, 40 RRP, and 21 LapRP. Pathological data collected included: prostate weight and volume, tumor volume (microscopically calculated LxWxD), Gleason Score (GS), pTNM, number and anatomic location of SM+ sites, SM+ type (at capsular incision vs EP) and total linear length of SM+. Available clinical data included: preop PSA, cTNM, BMI, nerve-sparing status, postoperative PSA/biochemical recurrence.
Results: Initial SM+ status assigned by original pathologist was reassigned in 1/38 RobRP, 3/40 RRP, 2/21 LapRP to SM- status (5% false positive). SM+ status was confirmed in remaining 94 RP. The 3 groups were comparable in regard to preop PSA, cTNM, pTNM and tumor volume (p:NS). However, patient weight and prostate gland volume were significantly different among groups (p<0.02). Overall, solitary positive margin was present in 65% of RRP, 47% of LapRP and 49% of RobRP. The apex was the most commonly SM+ site (35% in RRP, 26% in LapRP, and 29% in RobRP). Both total linear length and number of SM+ sites significantly correlated with GS and pTNM (p<0.01). Total linear length also correlated with preop PSA (p=0.0009). No significant overall difference among the 3 groups was found with respect to: total linear length, number, laterality or location of SM+ (p:NS).
Conclusions: Urologic pathologist review detected 5% false positive margin status assignment. As expected, patient weight and prostate gland volume affected selection of surgical technique. We found no significant difference in SM+ characteristics among the three techniques.Additional studies to assess any differences in future BCR are warranted.
Category: Genitourinary (including renal tumors)
Tuesday, March 10, 2009 1:00 PM
Poster Session IV # 132, Tuesday Afternoon