Positive Surgical Margins After Robotic Assisted Radical Prostatectomy: A Multi-Institutional Study

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Citações na Scopus
128
Tipo de produção
article
Data de publicação
2011
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
ELSEVIER SCIENCE INC
Autores
PATEL, Vipul R.
ROCCO, Bernardo
ORVIETO, Marcelo
SIVARAMAN, Ananthakrishnan
PALMER, Kenneth J.
KAMEH, Darien
SANTORO, Luigi
COUGHLIN, Geoff D.
LISS, Michael
Citação
JOURNAL OF UROLOGY, v.186, n.2, p.511-516, 2011
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Purpose: Positive surgical margins are an independent predictive factor for biochemical recurrence after radical prostatectomy. We analyzed the incidence of and associative factors for positive surgical margins in a multi-institutional series of 8,418 robotic assisted radical prostatectomies. Materials and Methods: We analyzed the records of 8,418 patients who underwent robotic assisted radical prostatectomy at 7 institutions. Of the patients 323 had missing data on margin status. Positive surgical margins were categorized into 4 groups, including apex, bladder neck, posterolateral and multifocal. The records of 6,169 patients were available for multivariate analysis. The variables entered into the logistic regression models were age, body mass index, preoperative prostate specific antigen, biopsy Gleason score, prostate weight and pathological stage. A second model was built to identify predictive factors for positive surgical margins in the subset of patients with organ confined disease (pT2). Results: The overall positive surgical margin rate was 15.7% (1,272 of 8,095 patients). The positive surgical margin rate for pT2 and pT3 disease was 9.45% and 37.2%, respectively. On multivariate analysis pathological stage (pT2 vs pT3 OR 4.588, p <0.001) and preoperative prostate specific antigen (4 or less vs greater than 10 ng/ml OR 2.918, p <0.001) were the most important independent predictive factors for positive surgical margins after robotic assisted radical prostatectomy. Increasing prostate weight was associated with a lower risk of positive surgical margins after robotic assisted radical prostatectomy (OR 0.984, p <0.001) and a higher body mass index was associated with a higher risk of positive surgical margins (OR 1.032, p <0.001). For organ confined disease preoperative prostate specific antigen was the most important factor that independently correlated with positive surgical margins (4 or less vs greater than 10 ng/ml OR 3.8, p <0.001). Conclusions: The prostatic apex followed by a posterolateral site was the most common location of positive surgical margins after robotic assisted radical prostatectomy. Factors that correlated with cancer aggressiveness, such as pathological stage and preoperative prostate specific antigen, were the most important factors independently associated with an increased risk of positive surgical margins after robotic assisted radical prostatectomy.
Palavras-chave
prostate, prostatic neoplasms, prostatectomy, robotics, neoplasm recurrence, local
URI
https://observatorio.fm.usp.br/handle/OPI/23611
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Coleções
Artigos e Materiais de Revistas Científicas - HC/ICESP