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Journal of Robotic Surgery

, Volume 6, Issue 4, pp 311–316 | Cite as

Predictors of positive surgical margins at open and robot-assisted laparoscopic radical prostatectomy: a single surgeon series

  • Mahesha Weerakoon
  • Shomik Sengupta
  • Kapil Sethi
  • Joseph Ischia
  • David R. Webb
Original Article

Abstract

Robot-assisted laparoscopic radical prostatectomy (RALRP), increasingly used to treat localized prostate cancer, has advantages over open radical prostatectomy (ORP) in terms of reduced bleeding and quicker convalescence. However, debate continues over whether RALRP provides superior or at least equivalent surgical outcomes. This study compares positive surgical margins (+SM), as a surrogate for long-term cancer control, at RALRP and ORP performed by a single experienced surgeon during the process of taking up RALRP. 400 consecutive patients undergoing surgery for prostate cancer under a single surgeon (DW) between November 1999 and July 2009 were studied. Prior to July 2005, all patients underwent ORP; after this date, most patients were treated by RALRP. Data were collected by retrospective chart review and analysed independently of the treating surgeon. +SM were defined as the presence of cancer at an inked surface. Overall, 23 (11.5%) of 200 patients undergoing RALRP had +SM, compared to 40 (20.0%) of 200 patients undergoing ORP (P < 0.05). On univariate logistic regression analysis, in addition to surgical approach (odds ratio [OR] = 1.92), patient age (OR = 1.05), pathologic stage (OR = 3.93) and specimen Gleason (GS) score (OR = 1.86) were significant predictors of +SM. On multivariate analysis, surgical approach, p-stage and specimen GS remained significant predictors of +SM. RALRP is associated with lower rates of +SM compared to ORP, even after adjusting for other known risk factors. Of note, the RALRP in this study were part of the surgeon’s learning curve.

Keywords

Prostatectomy, robotic Prostatectomy, open Prostate cancer Positive surgical margins Risk factors Multivariate analysis 

Notes

Conflict of interest

None.

References

  1. 1.
    Ficarra V, Novara G, Artibani W, Cestari A, Galfano A, Graefen M, Guazzoni G, Guillonneau B, Menon M, Montorsi F, Patel V, Rassweiler J, Van Poppel H (2009) Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol 55(5):1037–1063. doi: 10.1016/j.eururo.2009.01.036 PubMedCrossRefGoogle Scholar
  2. 2.
    Hu JC, Gu X, Lipsitz SR, Barry MJ, D’Amico AV, Weinberg AC, Keating NL (2009) Comparative effectiveness of minimally invasive vs open radical prostatectomy. JAMA 302(14):1557–1564. doi: 10.1001/jama.2009.1451 PubMedCrossRefGoogle Scholar
  3. 3.
    Boorjian SA, Karnes RJ, Crispen PL, Carlson RE, Rangel LJ, Bergstralh EJ, Blute ML (2010) The impact of positive surgical margins on mortality following radical prostatectomy during the prostate specific antigen era. J Urol 183 (3):1003–1009. doi: 10.1016/j.juro.2009.11.039 Google Scholar
  4. 4.
    Doumerc N, Yuen C, Savdie R, Rahman MB, Rasiah KK, Benito RP, Delprado W, Matthews J, Haynes AM, Stricker PD (2010) Should experienced open prostatic surgeons convert to robotic surgery? The real learning curve for one surgeon over 3 years. BJU Int 106(3):378–384. doi: 10.1111/j.1464-410X.2009.09158.x PubMedCrossRefGoogle Scholar
  5. 5.
    Ficarra V, Novara G, Fracalanza S, D’Elia C, Secco S, Iafrate M, Cavalleri S, Artibani W (2009) A prospective, non-randomized trial comparing robot-assisted laparoscopic and retropubic radical prostatectomy in one European institution. BJU Int 104(4):534–539. doi: 10.1111/j.1464-410X.2009.08419.x PubMedCrossRefGoogle Scholar
  6. 6.
    Krambeck AE, DiMarco DS, Rangel LJ, Bergstralh EJ, Myers RP, Blute ML, Gettman MT (2009) Radical prostatectomy for prostatic adenocarcinoma: a matched comparison of open retropubic and robot-assisted techniques. BJU Int 103(4):448–453. doi: 10.1111/j.1464-410X.2008.08012.x PubMedCrossRefGoogle Scholar
  7. 7.
    Laurila TA, Huang W, Jarrard DF (2009) Robotic-assisted laparoscopic and radical retropubic prostatectomy generate similar positive margin rates in low and intermediate risk patients. Urol Oncol 27(5):529–533. doi: 10.1016/j.urolonc.2008.05.001 PubMedCrossRefGoogle Scholar
  8. 8.
    Magheli A, Gonzalgo ML, Su LM, Guzzo TJ, Netto G, Humphreys EB, Han M, Partin AW, Pavlovich CP (2011) Impact of surgical technique (open vs laparoscopic vs robotic-assisted) on pathological and biochemical outcomes following radical prostatectomy: an analysis using propensity score matching. BJU Int 107:1956–1962. doi: 10.1111/j.1464-410X.2010.09795.x Google Scholar
  9. 9.
    O’Malley PJ, Van Appledorn S, Bouchier-Hayes DM, Crowe H, Costello AJ (2006) Robotic radical prostatectomy in Australia: initial experience. World J Urol 24(2):165–170. doi: 10.1007/s00345-006-0064-4 PubMedCrossRefGoogle Scholar
  10. 10.
    Rocco B, Matei DV, Melegari S, Ospina JC, Mazzoleni F, Errico G, Mastropasqua M, Santoro L, Detti S, de Cobelli O (2009) Robotic vs open prostatectomy in a laparoscopically naive centre: a matched-pair analysis. BJU Int 104(7):991–995. doi: 10.1111/j.1464-410X.2009.08532.x PubMedCrossRefGoogle Scholar
  11. 11.
    Schroeck FR, Sun L, Freedland SJ, Albala DM, Mouraviev V, Polascik TJ, Moul JW (2008) Comparison of prostate-specific antigen recurrence-free survival in a contemporary cohort of patients undergoing either radical retropubic or robot-assisted laparoscopic radical prostatectomy. BJU Int 102(1):28–32. doi: 10.1111/j.1464-410X.2008.07607.x PubMedCrossRefGoogle Scholar
  12. 12.
    Smith JA Jr, Chan RC, Chang SS, Herrell SD, Clark PE, Baumgartner R, Cookson MS (2007) A comparison of the incidence and location of positive surgical margins in robotic assisted laparoscopic radical prostatectomy and open retropubic radical prostatectomy. J Urol 178(6):2385–2389; discussion 2389–2390. doi: 10.1016/j.juro.2007.08.008 Google Scholar
  13. 13.
    Tewari A, Srivasatava A, Menon M (2003) A prospective comparison of radical retropubic and robot-assisted prostatectomy: experience in one institution. BJU Int 92(3):205–210PubMedCrossRefGoogle Scholar
  14. 14.
    White MA, De Haan AP, Stephens DD, Maatman TK, Maatman TJ (2009) Comparative analysis of surgical margins between radical retropubic prostatectomy and RALP: are patients sacrificed during initiation of robotics program? Urology 73(3):567–571. doi: 10.1016/j.urology.2008.11.011 PubMedCrossRefGoogle Scholar
  15. 15.
    Williams SB, Chen MH, D’Amico AV, Weinberg AC, Kacker R, Hirsch MS, Richie JP, Hu JC (2010) Radical retropubic prostatectomy and robotic-assisted laparoscopic prostatectomy: likelihood of positive surgical margin(s). Urology 76(5):1097–1101. doi: 10.1016/j.urology.2009.11.079 PubMedCrossRefGoogle Scholar
  16. 16.
    Ischia J, Sengupta S, Webb D (2010) Early release of pedicles and posterior development of the ‘Veil of Aphrodite’ in robotic-assisted laparoscopic prostatectomy (RALP). BJU Int 106(11):1856–1861. doi: 10.1111/j.1464-410X.2010.09920.x Google Scholar
  17. 17.
  18. 18.
    Berryhill R Jr, Jhaveri J, Yadav R, Leung R, Rao S, El-Hakim A, Tewari A (2008) Robotic prostatectomy: a review of outcomes compared with laparoscopic and open approaches. Urology 72(1):15–23. doi: 10.1016/j.urology.2007.12.038 PubMedCrossRefGoogle Scholar
  19. 19.
    Parsons JK, Bennett JL (2008) Outcomes of retropubic, laparoscopic, and robotic-assisted prostatectomy. Urology 72(2):412–416. doi: 10.1016/j.urology.2007.11.026 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Ltd 2011

Authors and Affiliations

  • Mahesha Weerakoon
    • 1
  • Shomik Sengupta
    • 1
    • 2
  • Kapil Sethi
    • 1
  • Joseph Ischia
    • 1
  • David R. Webb
    • 1
  1. 1.Department of UrologyAustin HealthHeidelbergAustralia
  2. 2.East MelbourneAustralia

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