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Linear extent of positive surgical margin impacts biochemical recurrence after robot-assisted radical prostatectomy in a high-volume center

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Abstract

The objective of this study is to evaluate if surgeon volume and stratifying positive surgical margins (PSM) into focal and non-focal may differentially impact the risk of biochemical recurrence (BCR) after robot-assisted radical prostatectomy (RARP). Between January 2013 and December 2017, 732 consecutive patients were evaluated. The population included negative cases (control group) and PSM subjects (study group). PSMs were stratified as focal (≤ 1 mm) or non-focal (> 1 mm). A logistic regression model assessed the independent association of factors with the risk of PSM. The risk of BCR of PSM and other factors was assessed by Cox’s multivariate proportional hazards. Overall, 192 (26.3%) patients had PSM focal in 133 patients; non-focal in 59 cases. Focal PSM was associated with the percentage of biopsy positive cores (BPC; OR 1.011; p = 0.015), extra-capsular extension (pT3a stage; OR 2.064; p = 0.016), seminal vesicle invasion (pT3b; OR 2.150; p = 0.010), body mass index (odds ratio, OR 0.914; p = 0.006), and high surgeon volume (OR 0.574; p = 0.006). BPC (OR 1.013; p = 0.044), pT3a (OR 4.832; p < 0.0001) and pT3b stage (OR 5.153; p = 0.001) were independent predictors of the risk of non-focal PSM. Surgeon volume was not a predictor of non-focal PSM (p = 0.224). Independent factors associated with the risk of BCR were baseline PSA (hazard ratio, HR 1.064; p = 0.004), BPC (HR 1.015; p = 0.027), ISUP biopsy grade group (BGG) 2/3 (HR 2.966; p 0.003) and BGG 4/5 (HR 3.122; p = 0.022) pathologic grade group 4/5 (HR 3.257; p = 0.001), pT3b (HR 2.900; p = 0.003), and non-focal PSM (HR 2.287; p = 0.012). Surgeon volume was not a predictor of BCR (p = 0.253). High surgeon volume is an independent factor that lowers the risk of focal PSM. Surgeon volume does not affect non-focal PSM and BCR. Negative as well as focal PSM are not associated with BCR.

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Author notes

  1. Antonio Benito Porcaro, Alessandro Tafuri, and Marco Sebben have contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Stefani 1, 37126, Verona, Italy

    Antonio Benito Porcaro, Alessandro Tafuri, Marco Sebben, Nelia Amigoni, Paolo Corsi, Tania Processali, Marco Pirozzi, Riccardo Rizzetto, Clara Cerrato, Leone Tiso, Filippo Migliorini, Giovanni Novella, Vincenzo De Marco, Salvatore Siracusano & Walter Artibani

  2. USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California (USC), Los Angeles, CA, USA

    Alessandro Tafuri & Aliasger Shakir

  3. Department of Pathology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy

    Riccardo Bernasconi & Matteo Brunelli

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  1. Antonio Benito Porcaro
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Contributions

ABP: project development, data analysis and interpretation, manuscript writing, and supervision. AT and MS: project development, data collection, data analysis and interpretation, and manuscript writing. PC, MP, TP, NA, RR, RB, CC, and LT: data collection. AS: language and critical revision. MB, VDeM, FM, GN, SS, MAC, AA, and WA: other (supervision and critical revision).

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Correspondence to Antonio Benito Porcaro.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all individual participants included in the study.

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Porcaro, A.B., Tafuri, A., Sebben, M. et al. Linear extent of positive surgical margin impacts biochemical recurrence after robot-assisted radical prostatectomy in a high-volume center. J Robotic Surg 14, 663–675 (2020). https://doi.org/10.1007/s11701-019-01039-5

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