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Impact of positive surgical margins on oncological outcome following laparoscopic radical prostatectomy (LRP): long-term results

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Abstract

Purpose

The impact of positive surgical margins (PSM) on biochemical recurrence (BCR) has been heavily debated in laparoscopic radical prostatectomy (LRP). The aim of this study was to investigate the impact of PSM on BCR following LRP in patients with extended follow-up.

Methods

Retrospective chart review of 1,845 patients who underwent LRP from 1999 to 2007. Predictors of PSM and BCR were identified utilizing univariate and multivariable logistic and Cox regression analyses, respectively.

Results

Five hundred and thirty-seven patients (29.1 %) had a PSM. Median postoperative follow-up was 56 months. 10-year BCR-free survival was 59.2 and 82.9 % for patients with and without PSM, respectively (p < 0.0001). Clinical stage T2 (OR 1.66; CI 1.23–2.25; p = 0.001), a biopsy Gleason sum > 7 (OR 1.84; CI 1.06–3.18; p = 0.031) and preoperative prostate-specific antigen (PSA) levels of 10–20 ng/mL (OR 1.58; CI 1.12–2.23; p = 0.010) and >20 ng/mL (OR 6.82; CI 3.51–13.27; p < 0.0001) were independent predictors of PSM. Prostate size was inversely associated with PSM (OR 0.99; CI 0.98–1.00; p = 0.002). On multivariable analysis, LRP Gleason score of 7 (HR 2.45; CI 1.67–3.40; p < 0.0001) and >7 (HR 4.76; CI 3.15–7.19; p < 0.0001), PSM (HR 1.49; CI 1.14–2.00; p = 0.003), advanced pathological stages (p < 0.001), and PSA 10–20 ng/mL (HR 1.46; CI 1.13–1.89; p = 0.004) were independent predictors of BCR.

Conclusions

We demonstrated the independent predictive value of PSM for BCR in our LRP cohort with extended follow-up. Our results could potentially be transferred to robotic RP, in which long-term follow-up is lacking.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Urology, Charité University Medicine Berlin, Berlin, Germany

    Jonas Busch, Annett Klutzny, Stefan Hinz, Carsten Kempkensteffen, Steffen Weikert, Kurt Miller & Ahmed Magheli

  2. Department of Pathology, Charité University Medicine Berlin, Berlin, Germany

    Ergin Kilic

  3. Berlin Institute for Urological Research, Berlin, Germany

    Carsten Stephan & Michael Lein

  4. Department of Urology, University Teaching Hospital, Offenbach, Germany

    Michael Lein

Authors
  1. Jonas Busch
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  2. Carsten Stephan
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  3. Annett Klutzny
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  4. Stefan Hinz
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  5. Carsten Kempkensteffen
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  6. Ergin Kilic
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  7. Michael Lein
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  8. Steffen Weikert
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  9. Kurt Miller
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  10. Ahmed Magheli
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Correspondence to Ahmed Magheli.

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Busch, J., Stephan, C., Klutzny, A. et al. Impact of positive surgical margins on oncological outcome following laparoscopic radical prostatectomy (LRP): long-term results. World J Urol 31, 395–401 (2013). https://doi.org/10.1007/s00345-012-0866-5

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  • DOI: https://doi.org/10.1007/s00345-012-0866-5

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