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

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorPATEL, Vipul R.
dc.contributor.authorCOELHO, Rafael F.
dc.contributor.authorROCCO, Bernardo
dc.contributor.authorORVIETO, Marcelo
dc.contributor.authorSIVARAMAN, Ananthakrishnan
dc.contributor.authorPALMER, Kenneth J.
dc.contributor.authorKAMEH, Darien
dc.contributor.authorSANTORO, Luigi
dc.contributor.authorCOUGHLIN, Geoff D.
dc.contributor.authorLISS, Michael
dc.contributor.authorJEONG, Wooju
dc.contributor.authorMALCOLM, John
dc.contributor.authorSTERN, Joshua M.
dc.contributor.authorSHARMA, Saurabh
dc.contributor.authorZORN, Kevin C.
dc.contributor.authorSHIKANOV, Sergey
dc.contributor.authorSHALHAV, Arieh L.
dc.contributor.authorZAGAJA, Gregory P.
dc.contributor.authorAHLERING, Thomas E.
dc.contributor.authorRHA, Koon H.
dc.contributor.authorALBALA, David M.
dc.contributor.authorFABRIZIO, Michael D.
dc.contributor.authorLEE, David I.
dc.contributor.authorCHAUHAN, Sanket
dc.date.accessioned2017-11-27T16:38:07Z
dc.date.available2017-11-27T16:38:07Z
dc.date.issued2011
dc.description.abstractPurpose: 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.
dc.description.indexMEDLINE
dc.identifier.citationJOURNAL OF UROLOGY, v.186, n.2, p.511-516, 2011
dc.identifier.doi10.1016/j.juro.2011.03.112
dc.identifier.issn0022-5347
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/23611
dc.language.isoeng
dc.publisherELSEVIER SCIENCE INC
dc.relation.ispartofJournal of Urology
dc.rightsrestrictedAccess
dc.rights.holderCopyright ELSEVIER SCIENCE INC
dc.subjectprostate
dc.subjectprostatic neoplasms
dc.subjectprostatectomy
dc.subjectrobotics
dc.subjectneoplasm recurrence
dc.subjectlocal
dc.subject.otherbody-mass index
dc.subject.otherlaparoscopic prostatectomy
dc.subject.otherretropubic prostatectomy
dc.subject.otherbiochemical recurrence
dc.subject.otherrisk-factors
dc.subject.otheroutcomes
dc.subject.otherimpact
dc.subject.otherlocation
dc.subject.othercancer
dc.subject.otherweight
dc.subject.wosUrology & Nephrology
dc.titlePositive Surgical Margins After Robotic Assisted Radical Prostatectomy: A Multi-Institutional Study
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.affiliation.countryEstados Unidos
hcfmusp.affiliation.countryItália
hcfmusp.affiliation.countryCoréia do Sul
hcfmusp.affiliation.countryisous
hcfmusp.affiliation.countryisoit
hcfmusp.affiliation.countryisokr
hcfmusp.author.externalPATEL, Vipul R.:Univ Cent Florida, Coll Med, Florida Hosp Celebrat Hlth, Global Robot Inst, Orlando, FL 32816 USA
hcfmusp.author.externalROCCO, Bernardo:Univ Cent Florida, Coll Med, Florida Hosp Celebrat Hlth, Global Robot Inst, Orlando, FL 32816 USA; Univ Milan, Sez Urol, Milan, Italy
hcfmusp.author.externalORVIETO, Marcelo:Univ Cent Florida, Coll Med, Florida Hosp Celebrat Hlth, Global Robot Inst, Orlando, FL 32816 USA
hcfmusp.author.externalSIVARAMAN, Ananthakrishnan:Univ Cent Florida, Coll Med, Florida Hosp Celebrat Hlth, Global Robot Inst, Orlando, FL 32816 USA
hcfmusp.author.externalPALMER, Kenneth J.:Univ Cent Florida, Coll Med, Florida Hosp Celebrat Hlth, Global Robot Inst, Orlando, FL 32816 USA
hcfmusp.author.externalKAMEH, Darien:Univ Cent Florida, Coll Med, Florida Hosp Celebrat Hlth, Global Robot Inst, Orlando, FL 32816 USA
hcfmusp.author.externalSANTORO, Luigi:Univ Cent Florida, Coll Med, Florida Hosp Celebrat Hlth, Global Robot Inst, Orlando, FL 32816 USA
hcfmusp.author.externalCOUGHLIN, Geoff D.:Univ Cent Florida, Coll Med, Florida Hosp Celebrat Hlth, Global Robot Inst, Orlando, FL 32816 USA
hcfmusp.author.externalLISS, Michael:Univ Calif Irvine, Irvine, CA USA
hcfmusp.author.externalJEONG, Wooju:Yonsei Univ, Coll Med, Seoul, South Korea
hcfmusp.author.externalMALCOLM, John:E Virginia Med Sch, Norfolk, VA USA
hcfmusp.author.externalSTERN, Joshua M.:Univ Penn, Sch Med, Philadelphia, PA 19104 USA
hcfmusp.author.externalSHARMA, Saurabh:Univ Penn, Sch Med, Philadelphia, PA 19104 USA
hcfmusp.author.externalZORN, Kevin C.:Univ Chicago, Med Ctr, Chicago, IL 60637 USA
hcfmusp.author.externalSHIKANOV, Sergey:Univ Chicago, Med Ctr, Chicago, IL 60637 USA
hcfmusp.author.externalSHALHAV, Arieh L.:Univ Chicago, Med Ctr, Chicago, IL 60637 USA
hcfmusp.author.externalZAGAJA, Gregory P.:Univ Chicago, Med Ctr, Chicago, IL 60637 USA
hcfmusp.author.externalAHLERING, Thomas E.:Univ Calif Irvine, Irvine, CA USA
hcfmusp.author.externalRHA, Koon H.:Yonsei Univ, Coll Med, Seoul, South Korea
hcfmusp.author.externalALBALA, David M.:Duke Univ, Med Ctr, Durham, NC USA
hcfmusp.author.externalFABRIZIO, Michael D.:E Virginia Med Sch, Norfolk, VA USA
hcfmusp.author.externalLEE, David I.:Univ Penn, Sch Med, Philadelphia, PA 19104 USA
hcfmusp.author.externalCHAUHAN, Sanket:Univ Cent Florida, Coll Med, Florida Hosp Celebrat Hlth, Global Robot Inst, Orlando, FL 32816 USA
hcfmusp.citation.scopus128
hcfmusp.contributor.author-fmusphcRAFAEL FERREIRA COELHO
hcfmusp.description.beginpage511
hcfmusp.description.endpage516
hcfmusp.description.issue2
hcfmusp.description.volume186
hcfmusp.origemWOS
hcfmusp.origem.pubmed21680001
hcfmusp.origem.scopus2-s2.0-79960171435
hcfmusp.origem.wosWOS:000292545100042
hcfmusp.publisher.cityNEW YORK
hcfmusp.publisher.countryUSA
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