Comparison between Robotic Radical Prostatectomy and Open Radical Prostatectomy: Surgical Margin Status Against TNM Stage, Gleason's Score, and Tumor Volume
MP Mikulasovich, S Noreen, DB Samadi, MT Idrees, Y Liu, F Nabizada-Pace, PD Unger, GQ Xiao. The Mount Sinai Hospital, New York, NY; Indiana University Hospital, Indianapolis, IN
Background: Robotic-assisted laparoscopic prostatectomy (RALP) is a recently developed minimally invasive alternative for prostate cancer. Its advantage over open procedure is still under evaluation, particularly in terms of surgical margin status, which is considered one of the key elements affecting patient's long-term outcome.
Design: To assess the degree of completion in excision of tumor between these two procedures, surgical margin was evaluated against the following parameters: pathologic stage, Gleason's score, and tumor volume. Intragroup assessment was also performed. A total of 584 consecutive RALPs performed over the last 1-year period and 218 open radical prostatectomies (ORPs) over the last 2-year period were retrospectively reviewed. Tumor TNM pathologic stage was divided into pT2 and pT3, Gleason's score (GS) into GS 6, GS 7, and GS 8-10, and tumor volume into <40% and 40%. Margin was assessed under each parameter.
Results: Results are summarized in table 1.
Table 1: Surgical margin status against TNM stage, Gleason's score and tumor volume
|RALP margin status||ORP margin status|
|pT2||60 (12%)||438||43 (22%)||151|
|pT3||54 (63%)||32||19 (79%)||5|
|GS 6||11 (6%)||190||13 (17%)||64|
|GS 7||86 (24%)||267||44 (34%)||85|
|GS 8-10||17 (57%)||13||5 (41%)||7|
|<40%||35 (11%)||278||14 (16%)||82|
|40%||79 (29%)||192||48 (39%)||74|
Conclusions: With the only exception of Gleason's score 8-10, when compared to ORP stage for stage, Gleason's scores for the same Gleason's scores and tumor volume for tumor volume, the percentages of positive margin incidences in RALP were significantly lower. For the Gleason's score 8-10, however, a conclusion as to the difference of positive margin incidences between ORP and RALP cannot be drawn justifiably in this study owing to the small size of samples for both RALP and ORP (in particular ORP). On intragroup comparison for both RALP and ORP, with increase of stage, Gleason's scores and tumor volume, the percentages of positive margin incidences increased significantly. In conclusion, in addition to its advantage of short hospitalization, the results of this study supported a robotic approach which provided a significantly higher rate of tumor free surgical margin compared to ORP.
Category: Genitourinary (including renal tumors)
Tuesday, March 10, 2009 9:30 AM
Poster Session III # 90, Tuesday Morning