Effect of Robotic-Assisted Laparoscopic Prostatectomy on Surgical Pathology Specimens.
Heng Hong, Lin Mel, Jonathan Taylor, Qiang Wu, Hugh Reeves, Amanda Allan. Brody School of Medicine at East Carolina University, Greenville, NC; Eastern Urological Associates, P.A., Greenville, NC; College of Allied Health Sciences at East Carolina University, Greenville, NC
Background: Robotic-assisted laparoscopic prostatectomy (RALP) is a technique evolved over the last decade with significant efforts in improving functional outcomes following surgery. Currently, it is estimated that about 80% of prostatectomies in the USA are performed using RALP. It is interesting for pathologists and urologists to compare RALP with conventional open radical retropubic prostatectomy (RRP), and evaluate their effect on surgical pathology specimens.
Design: RALP and RRP procedures performed from 2007 to 2010 in our institution were retrospectively reviewed. Relevant data were collected from surgical pathology reports, and statistically analyzed.
Results: RALP group contains 104 patients with average age 61.4, Gleason score 6.60, tumor volume percentage 29.7%, and 63% of the patients at T2c stage; RRP group contains 42 patients with average age 60.6, Gleason score 7.05, tumor volume percentage 38.6%, and 68% of the patients at T2c stage. Comparison of these two groups shows that 28.9% of RALP and 66.7% of RRP have positive surgical margins, with statistically significant difference (P<0.001). If only patients at T2c stage are compared, the positive surgical margin is 25.4% for RALP and 60.7% for RRP (P<0.002). We further used a logistic regression model to adjust the difference in cancer stage, tumor volume percentage and Gleason score between these two groups in comparing the positive surgical margin rates. The odds ratio of RALP versus RRP is 0.20 with a 95% confidence interval (0.08, 0.52), suggesting highly significant difference in the two procedures (P<0.001). No significant difference is noted for tumor involvement in apex and bladder base margins between two groups (P>0.05). The size of seminal vesicles in RALP specimen (average 5.12 cm3) is interestingly larger than that of RRP (1.20 cm3, P<0.001), although this probably has no considerable effect on patient management. Comparison of RALP performed by different surgeons shows no significant difference in positive surgical margin rates (P=0.83).
Conclusions: RALP has become a new technique widely accepted by urologists and patients. The major change brought to surgical specimens by RALP is reduced positive surgical margins. This conclusion is made after adjusting the cancer stage, tumor volume percentage and Gleason score in patients from both RALP and RRP groups.
Category: Genitourinary (including renal tumors)
Monday, February 28, 2011 1:00 PM
Poster Session II # 125, Monday Afternoon