UroToday - Risk-Adjusted Analysis of Positive Surgical Margins Following Laparoscopic and Retropubic Radical Prostatectomy

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Thursday, 17 January 2008

BERKELEY, CA

(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

PubMed

Abstract

PMID: 17188801