Produção Nacional
Revisado por pares
Positive Surgical Margins After Robotic Assisted Radical Prostatectomy: A Multi-Institutional Study
2011; Lippincott Williams & Wilkins; Volume: 186; Issue: 2 Linguagem: Inglês
10.1016/j.juro.2011.03.112
ISSN1527-3792
AutoresVipul Patel, Rafael F. Coelho, Bernardo Rocco, Marcelo A. Orvieto, Ananthakrishnan Sivaraman, Kenneth J. Palmer, Darien Kameh, Luigi Santoro, Geoff Coughlin, Michael A. Liss, Wooju Jeong, John B. Malcolm, Joshua M. Stern, Saurabh Sharma, Kevin C. Zorn, Sergey Shikanov, Arieh L. Shalhav, Gregory P. Zagaja, Thomas E. Ahlering, Koon Ho Rha, David Albala, Michael D. Fabrizio, David I. Lee, Sanket Chauhan,
Tópico(s)Urologic and reproductive health conditions
ResumoNo AccessJournal of UrologyAdult Urology1 Aug 2011Positive Surgical Margins After Robotic Assisted Radical Prostatectomy: A Multi-Institutional Study Vipul R. Patel, Rafael F. Coelho, Bernardo Rocco, Marcelo Orvieto, Ananthakrishnan Sivaraman, Kenneth J. Palmer, Darien Kameh, Luigi Santoro, Geoff D. Coughlin, Michael Liss, Wooju Jeong, John Malcolm, Joshua M. Stern, Saurabh Sharma, Kevin C. Zorn, Sergey Shikanov, Arieh L. Shalhav, Gregory P. Zagaja, Thomas E. Ahlering, Koon H. Rha, David M. Albala, Michael D. Fabrizio, David I. Lee, and Sanket Chauhan Vipul R. PatelVipul R. Patel Global Robotics Institute, Florida Hospital-Celebration Health, University of Central Florida College of Medicine, Orlando, Florida , Rafael F. CoelhoRafael F. Coelho Global Robotics Institute, Florida Hospital-Celebration Health, University of Central Florida College of Medicine, Orlando, Florida Hospital Israelita Albert Einstein and Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil , Bernardo RoccoBernardo Rocco Global Robotics Institute, Florida Hospital-Celebration Health, University of Central Florida College of Medicine, Orlando, Florida Sezione di Urolagia-Università degli Studi di Milano, Milan, Italy , Marcelo OrvietoMarcelo Orvieto Global Robotics Institute, Florida Hospital-Celebration Health, University of Central Florida College of Medicine, Orlando, Florida , Ananthakrishnan SivaramanAnanthakrishnan Sivaraman Global Robotics Institute, Florida Hospital-Celebration Health, University of Central Florida College of Medicine, Orlando, Florida , Kenneth J. PalmerKenneth J. Palmer Global Robotics Institute, Florida Hospital-Celebration Health, University of Central Florida College of Medicine, Orlando, Florida , Darien KamehDarien Kameh Global Robotics Institute, Florida Hospital-Celebration Health, University of Central Florida College of Medicine, Orlando, Florida , Luigi SantoroLuigi Santoro Global Robotics Institute, Florida Hospital-Celebration Health, University of Central Florida College of Medicine, Orlando, Florida , Geoff D. CoughlinGeoff D. Coughlin Global Robotics Institute, Florida Hospital-Celebration Health, University of Central Florida College of Medicine, Orlando, Florida , Michael LissMichael Liss University of California-Irvine, Irvine, California , Wooju JeongWooju Jeong Yonsei University College of Medicine, Seoul, Republic of Korea , John MalcolmJohn Malcolm East Virginia Medical School, Norfolk, Virginia , Joshua M. SternJoshua M. Stern School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania , Saurabh SharmaSaurabh Sharma School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania , Kevin C. ZornKevin C. Zorn University of Chicago Medical Center, Chicago, Illinois , Sergey ShikanovSergey Shikanov University of Chicago Medical Center, Chicago, Illinois , Arieh L. ShalhavArieh L. Shalhav University of Chicago Medical Center, Chicago, Illinois , Gregory P. ZagajaGregory P. Zagaja University of Chicago Medical Center, Chicago, Illinois , Thomas E. AhleringThomas E. Ahlering University of California-Irvine, Irvine, California , Koon H. RhaKoon H. Rha Yonsei University College of Medicine, Seoul, Republic of Korea , David M. AlbalaDavid M. Albala Duke University Medical Center, Durham, North Carolina , Michael D. FabrizioMichael D. Fabrizio East Virginia Medical School, Norfolk, Virginia , David I. LeeDavid I. Lee School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania , and Sanket ChauhanSanket Chauhan Global Robotics Institute, Florida Hospital-Celebration Health, University of Central Florida College of Medicine, Orlando, Florida View All Author Informationhttps://doi.org/10.1016/j.juro.2011.03.112AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: 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. References 1 : Positive surgical margins after radical prostatectomy: do they have an impact on biochemical or clinical progression?. BJU Int2008; 102: 1413. Google Scholar 2 : Impact of radical prostatectomy positive surgical margins on fear of cancer recurrence: results from CaPSURE™. Urol Oncol2010; 28: 268. Google Scholar 3 : Preoperative prediction of surgical margin status in patients with prostate cancer treated by radical prostatectomy. J Clin Oncol2000; 18: 2862. Google Scholar 4 : The impact of surgical approach (nerve bundle preservation versus wide local excision) on surgical margins and biochemical recurrence following radical prostatectomy. J Urol2004; 172: 1328. Link, Google Scholar 5 : Risk of positive margins and biochemical recurrence in relation to nerve-sparing radical prostatectomy. J Clin Oncol2002; 20: 1853. Google Scholar 6 : Analysis of risk factors associated with prostate cancer extension to the surgical margin and pelvic node metastasis at radical prostatectomy. J Urol1993; 150: 1845. Link, Google Scholar 7 : A comparison of the incidence and location of positive surgical margins in robotic assisted laparoscopic radical prostatectomy and open retropubic radical prostatectomy. J Urol2007; 178: 2385. Link, Google Scholar 8 : Comparative analysis of surgical margins between radical retropubic prostatectomy and RALP: are patients sacrificed during initiation of robotics program?. Urology2009; 73: 567. Google Scholar 9 : Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol2009; 55: 1037. Google Scholar 10 : Positive surgical margins in radical prostatectomy: outlining the problem and its long-term consequences. Eur Urol2009; 55: 87. Google Scholar 11 : Positive surgical margins during robotic radical prostatectomy: a contemporary analysis of risk factors. BJU Int2008; 102: 603. Google Scholar 12 : Predictors of positive surgical margins after laparoscopic robot assisted radical prostatectomy. J Urol2009; 182: 2682. Link, Google Scholar 13 : predictive factors for positive surgical margins and their locations after robot-assisted laparoscopic radical prostatectomy. Eur Urol2010; 57: e53. Google Scholar 14 : Incidence, etiology, location, prevention and treatment of positive surgical margins after radical prostatectomy for prostate cancer. J Urol1998; 160: 299. Link, Google Scholar 15 : Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol2009; 55: 1037. Google Scholar 16 : Robotic-assisted radical prostatectomy: a review of current outcomes. BJU Int2009; 104: 1428. Google Scholar 17 : Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a critical review of outcomes reported by high-volume centers. J Endourol2010; 24: 2003. Google Scholar 18 : Laparoscopic radical prostatectomy: oncological evaluation after 1,000 cases at Montsouris Institute. J Urol2003; 169: 1261. Link, Google Scholar 19 : Location of positive surgical margins after retropubic, perineal, and laparoscopic radical prostatectomy for organ-confined prostate cancer. Urology2003; 61: 386. Google Scholar 20 : Impact of urethral stump length on continence and positive surgical margins in robot-assisted laparoscopic prostatectomy. Urology2007; 70: 173. Google Scholar 21 : Prognostic significance of location of positive margins in radical prostatectomy specimens. Urology2007; 70: 965. Google Scholar 22 : Impact of positive apical surgical margins on likelihood of biochemical recurrence after radical prostatectomy. J Urol2009; 182: 2695. Link, Google Scholar 23 : Biochemical failure in men following radical retropubic prostatectomy: impact of surgical margin status and location. J Urol2004; 172: 129. Link, Google Scholar 24 : Effect of prostate weight on operative and postoperative outcomes of robotic-assisted laparoscopic prostatectomy. Urology2007; 69: 300. Google Scholar 25 : The impact of prostate gland weight in robot assisted laparoscopic radical prostatectomy. J Urol2008; 180: 928. Link, Google Scholar 26 : Impact of body mass index on outcomes after robot assisted radical prostatectomy. World J Urol2008; 26: 91. Google Scholar 27 : Increasing body mass index negatively impacts outcomes following robotic radical prostatectomy. JSLS2007; 11: 438. Google Scholar 28 : Robotic radical prostatectomy in overweight and obese patients: oncological and validated-functional outcomes. Urology2009; 73: 316. Google Scholar 29 : High body mass index does not affect outcomes following robotic assisted laparoscopic prostatectomy. Can J Urol2010; 17: 5291. Google Scholar 30 : Techniques of nerve-sparing and potency outcomes following robot-assisted laparoscopic prostatectomy. Int Braz J Urol2010; 36: 259. Google Scholar © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byFaisal F, Tosoian J, Han M, Macura K, Pavlovich C and Lotan T (2019) Clinical, Pathological and Oncologic Findings of Radical Prostatectomy with Extraprostatic Extension Diagnosed on Preoperative Prostate BiopsyJournal of Urology, VOL. 201, NO. 5, (937-942), Online publication date: 1-May-2019.Hussein A, Welty C, Ameli N, Cowan J, Leapman M, Porten S, Shinohara K and Carroll P (2018) Untreated Gleason Grade Progression on Serial Biopsies during Prostate Cancer Active Surveillance: Clinical Course and Pathological OutcomesJournal of Urology, VOL. 194, NO. 1, (85-90), Online publication date: 1-Jul-2015.Nyarangi-Dix J, Radtke J, Hadaschik B, Pahernik S and Hohenfellner M (2018) Impact of Complete Bladder Neck Preservation on Urinary Continence, Quality of Life and Surgical Margins After Radical Prostatectomy: A Randomized, Controlled, Single Blind TrialJournal of Urology, VOL. 189, NO. 3, (891-898), Online publication date: 1-Mar-2013.Liss M, Lusch A, Morales B, Beheshti N, Skarecky D, Narula N, Osann K and Ahlering T (2018) Robot-Assisted Radical Prostatectomy: 5-Year Oncological and Biochemical OutcomesJournal of Urology, VOL. 188, NO. 6, (2205-2211), Online publication date: 1-Dec-2012. Volume 186Issue 2August 2011Page: 511-517 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.Keywordsprostateprostatic neoplasmsroboticsprostatectomyneoplasm recurrencelocalMetricsAuthor Information Vipul R. Patel Global Robotics Institute, Florida Hospital-Celebration Health, University of Central Florida College of Medicine, Orlando, Florida More articles by this author Rafael F. Coelho Global Robotics Institute, Florida Hospital-Celebration Health, University of Central Florida College of Medicine, Orlando, Florida Hospital Israelita Albert Einstein and Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil More articles by this author Bernardo Rocco Global Robotics Institute, Florida Hospital-Celebration Health, University of Central Florida College of Medicine, Orlando, Florida Sezione di Urolagia-Università degli Studi di Milano, Milan, Italy More articles by this author Marcelo Orvieto Global Robotics Institute, Florida Hospital-Celebration Health, University of Central Florida College of Medicine, Orlando, Florida More articles by this author Ananthakrishnan Sivaraman Global Robotics Institute, Florida Hospital-Celebration Health, University of Central Florida College of Medicine, Orlando, Florida More articles by this author Kenneth J. Palmer Global Robotics Institute, Florida Hospital-Celebration Health, University of Central Florida College of Medicine, Orlando, Florida More articles by this author Darien Kameh Global Robotics Institute, Florida Hospital-Celebration Health, University of Central Florida College of Medicine, Orlando, Florida More articles by this author Luigi Santoro Global Robotics Institute, Florida Hospital-Celebration Health, University of Central Florida College of Medicine, Orlando, Florida More articles by this author Geoff D. Coughlin Global Robotics Institute, Florida Hospital-Celebration Health, University of Central Florida College of Medicine, Orlando, Florida More articles by this author Michael Liss University of California-Irvine, Irvine, California More articles by this author Wooju Jeong Yonsei University College of Medicine, Seoul, Republic of Korea More articles by this author John Malcolm East Virginia Medical School, Norfolk, Virginia More articles by this author Joshua M. Stern School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania More articles by this author Saurabh Sharma School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania More articles by this author Kevin C. Zorn University of Chicago Medical Center, Chicago, Illinois More articles by this author Sergey Shikanov University of Chicago Medical Center, Chicago, Illinois More articles by this author Arieh L. Shalhav University of Chicago Medical Center, Chicago, Illinois More articles by this author Gregory P. Zagaja University of Chicago Medical Center, Chicago, Illinois More articles by this author Thomas E. Ahlering University of California-Irvine, Irvine, California More articles by this author Koon H. Rha Yonsei University College of Medicine, Seoul, Republic of Korea More articles by this author David M. Albala Duke University Medical Center, Durham, North Carolina Financial interest and/or other relationship with GlaxoSmithKline, Sanofi-Aventis and Applied Medical. More articles by this author Michael D. Fabrizio East Virginia Medical School, Norfolk, Virginia More articles by this author David I. Lee School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania More articles by this author Sanket Chauhan Global Robotics Institute, Florida Hospital-Celebration Health, University of Central Florida College of Medicine, Orlando, Florida More articles by this author Expand All Advertisement PDF downloadLoading ...
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