Skip to main content
SpringerLink
Log in

Incidence and location of positive surgical margins following open, pure laparoscopic, and robotic-assisted radical prostatectomy and its relation with neurovascular preservation: a single-institution experience

  • Original Article
  • Published:
Journal of Robotic Surgery Aims and scope Submit manuscript

Abstract

To evaluate whether robotic-assisted radical prostatectomy (dvRP) provides adequate local control of the disease, incidence of positive surgical margins (PSMs) obtained with dvRP was compared with that of laparoscopic radical prostatectomy (LRP) and with that of open radical retropubic prostatectomy (RRP) performed in a single institution by the same surgeons. We also studied whether neurovascular bundle preservation modified PSM rates. The records were retrospectively reviewed from electronic medical data, and three groups of 100 patients were organized. Group 1 included 100 patients who underwent RRP prior to the incorporation of minimally invasive techniques. Group 2 included the first 100 patients who underwent LRP, and group 3 was made up of the first 100 patients who underwent dvRP. All surgical specimens were analyzed by the same pathologist. We used the technique described by Patel et al. for dvRP. LRP was performed using a five-trocar extraperitoneal approach as previously published by the authors. RRP was performed using retrograde dissection as described by Walsh et al. The final decision of preserving neurovascular bundles was made during surgery. Using D’Amico’s risk classification, the dvRP group had a lower percentage of patients with low risk (dvRP versus LRP p = 0.017; dvRP versus RRP p = 0.0108). No statistically significant differences were found within high- and intermediate-risk groups. A higher percentage of patients with pT3 disease was found in the dvRP group compared with the RRP group (p = 0.0408). There were no statistically significant differences regarding PSMs among groups (RRP: 25, LRP: 14, dvRP: 18), although when we compared the total number of PSMs we found that the dvRP group had 18 PSMs versus 21 and 50 PSMs for LRP and RRP, respectively. All three groups had more PSMs located posterolaterally. There was a higher percentage of nerve-sparing procedures in the dvRP group (dvRP: 91 patients, LRP: 47 patients, RRP: 5 patients) (p < 0.0001). No statistically significant differences were found in the PSM rates between the three techniques analyzed. The number of nerve-sparing procedures in the dvRP group was statistically higher. However, this preservation did not modify PSM rates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Martinez-Salamanca JI, Romero OteroJ (2007) Análisis crítico de prostatectomía radical abierta, laparoscopica y robotica: resultados de morbilidad perioperatoria y control oncológico (Parte I). Arch Esp Urol 70(7):755–765

    Google Scholar 

  2. Cheng L, Slezak J, Bergstralh E et al (2000) Preoperative prediction of surgical margin status in patients with prostate cancer treated by radical prostatectomy. J Clin Oncol 18(15):2862–2868

    PubMed  CAS  Google Scholar 

  3. Gettman MT, Blute ML (2006) Critical comparison of laparoscopic, robotic, and open radical prostatectomy: techniques, outcomes, and cost. Curr Urol Rep 7:193–199

    Article  PubMed  Google Scholar 

  4. Cheng L, Darson M, Bergstralh E et al (1999) Correlation of margin status and extraprostatic extension with progression of prostate carcinoma. Cancer 86:1775–1782

    Article  PubMed  CAS  Google Scholar 

  5. Swindle P, Eastham JA, Ohori M (2005) Do margins matter? The prognostic significance of positive surgical margins in radical prostatectomy specimens. J Urol 174:903–907

    Article  PubMed  Google Scholar 

  6. Gettman MT, Blute ML (2010) Radical prostatectomy: does surgical technique influence margin control? Urol Oncol 28:219–225

    Article  PubMed  Google Scholar 

  7. Grossfield GD, Chang JJ, Broering JM et al (2000) Impact of positive surgical margins on prostate cancer recurrence and the use of secondary cancer treatment: data from de CapSURE database. J Urol 163:1171–1177

    Article  Google Scholar 

  8. Binder J, Kramer W (2001) Robotically-assisted laparoscopic radical prostatectomy. BJU Int 87:408–410

    Article  PubMed  CAS  Google Scholar 

  9. Abbou CC, Hoznek A, Salomon L et al (2000) Remote laparoscopic radical prostatectomy carried out with a robot. Report of a case. Prog Urol 10:520–523

    PubMed  CAS  Google Scholar 

  10. Menon M, Tewari A, Peabody JO et al (2004) Vattikuti Institute prostatectomy, a technique of robotic radical prostatectomy for management of localized carcinoma of the prostate: experience of over 1100 cases. Urol Clin N Am 31:701–717

    Article  Google Scholar 

  11. D′Amico AV, Whittington R, Malkowicz SB et al (1999) Pretreatment nomogram for prostate-specific antigen recurrence after radical prostatectomy or external-beam radiation therapy for clinically localized prostate cancer. J Clin Oncol 17:168–172

    PubMed  Google Scholar 

  12. Patel VR, Tully AS, Holmes R, Lindsay J (2005) Robotic radical prostatectomy in the community setting- the learning curve and beyond: initial 200 cases. J Urol 174(1):269–272

    Article  PubMed  Google Scholar 

  13. Villamil W, Giudice C, Jurado P et al (2006) Dos años de experiencia en prostatectomía radical laparoscópica (Primeros 37 Casos). Rev Arg Urol 71:43

    Google Scholar 

  14. Walsh PC, Lepor H, Eggleston JD (1983) Radical prostatectomy with preservation of sexual function: anatomical and pathologic considerations. Prostate 4:473

    Article  PubMed  CAS  Google Scholar 

  15. Sobin LH, Wittekind Ch (eds) (2002) International Union Against Cancer (UICC): TNM Classification of malignant tumours, 6th edn. Wiley, New York, pp 184–187

    Google Scholar 

  16. Ohori M, Scardino PT (2002) Localized prostate cáncer. Curr Probl Surg 833

  17. Ficarra V, Novara G, Artibani W et al (2009) Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol 55:1037–1063

    Article  PubMed  Google Scholar 

  18. Ficarra V, Cacalleri S, Novara G et al (2007) Evidence from robot-assisted laparoscopic radical prostatectomy: a systematic review. Eur Urol 51:45–56

    Article  PubMed  Google Scholar 

  19. Hermann TR, Rabenalt R, Stolzenburg JU et al (2007) Oncologic and functional results of open, robot-assisted and laparoscopic radical prostatectomy: does surgical technique and surgical experience matter? World J Urol 25:149–160

    Article  Google Scholar 

  20. Ahlering TE, Eichel L, Edwards RA et al (2004) Robotic radical prostatectomy: a technique to reduce pT2 positive margins. Urology 64:1224–1228

    Article  PubMed  Google Scholar 

  21. Herrel SD, Smith JA Jr (2005) Robotic-assisted laparoscopic prostatectomy: what is the learning curve? Urology 66:105

    Article  Google Scholar 

  22. Menon M, Tewari A, Baize B, Guillonneau B, Vallancien G (2002) Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vatticuti Urology Institute experience. Urology 60:864–868

    Article  PubMed  Google Scholar 

  23. Dahl D, He W, Lazarus R et al (2006) Pathologic outcomes of laparoscopic and open radical prostatectomy. Urology 68:1253–1256

    Article  PubMed  Google Scholar 

  24. Blute ML, Bostwick DG, Bergstralh EG et al (1997) Anatomic site-specific positive margins in organ-confined prostate cancer and its impact on outcome after radical prostatectomy. Urology 50:733–739

    Article  PubMed  CAS  Google Scholar 

  25. Brown JA, Garlitz C, Gomella LG et al (2003) Pathologic comparison of laparoscopic vs. open radical retropubic prostatectomyspecimens. Urology 62:481–486

    Article  PubMed  Google Scholar 

  26. Smith JA, Chan RC, Chang SS et al (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 178:2385–2390

    Article  PubMed  Google Scholar 

  27. Tsuboi T, Ohori M, Kuroiwa K et al (2005) Is intraoperative frozen section analysis an efficient way to reduce positive surgical margins? Urology 66:1287–1291

    Article  PubMed  Google Scholar 

  28. Ward JF, Zincke H, Bergstralh EJ et al (2004) The impact of surgical approach (nerve bundle preservation versus wide local excision) on surgical margins and biochemical recurrence following radical prostatectomy. J Urol 172:1328–1332

    Article  PubMed  Google Scholar 

  29. Secin FP, Serio A, Bianco FJ et al (2007) Preoperative and intraoperative risk factors for side-specific positive surgical margins in laparoscopic radical prostatectomy for prostate cancer. Eur Urol 51:764–771

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Urology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    W. Villamil, N. Billordo Peres, P. Martinez, C. Giudice, J. Liyo, P. García Marchiñena, A. Jurado & O. Damia

Authors
  1. W. Villamil
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. Billordo Peres
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Martinez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Giudice
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Liyo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. García Marchiñena
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. Jurado
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. O. Damia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to W. Villamil.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Villamil, W., Billordo Peres, N., Martinez, P. et al. Incidence and location of positive surgical margins following open, pure laparoscopic, and robotic-assisted radical prostatectomy and its relation with neurovascular preservation: a single-institution experience. J Robotic Surg 7, 21–27 (2013). https://doi.org/10.1007/s11701-012-0335-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11701-012-0335-6

Keywords

Search

Navigation