1555 THE RISK OF IATROGENIC POSITIVE MARGIN IN RADICAL PROSTATECTOMY: AN EXPENDED CRITERION TO EVALUATE THE QUALITY OF SURGICAL RESECTION

Abstract

You have accessJournal of UrologyProstate Cancer: Localized VI1 Apr 20101555 THE RISK OF IATROGENIC POSITIVE MARGIN IN RADICAL PROSTATECTOMY: AN EXPENDED CRITERION TO EVALUATE THE QUALITY OF SURGICAL RESECTION Christian Barré, Geneviève Aillet, and Matthieu Thoulouzan Christian BarréChristian Barré Nantes, France More articles by this author , Geneviève AilletGeneviève Aillet Nantes, France More articles by this author , and Matthieu ThoulouzanMatthieu Thoulouzan Toulouse, France More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1320AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Conventionally, the rate of positive surgical margins (PSM) for pT2 tumors, i.e. iatrogenic positive margins (IPM), is taken as the technical error rate. However, this is not a good indicator of technical error as it concerns dissection errors involving only malignant and not benign tissue. The technical error rate should also include the risk of IPM i.e. all incisions of benign tissue within the histological limits of the prostate defined by McNeal because the incised tissue might just as well have been malignant as benign. Even if the benign proved to be benign, this did not eliminate the risk that was run. The safety of a technique does not depend only on the known consequences of an error such as a PSM (″adverse events″) but also on the number of times errors with potentially deleterious consequences are made (″near-misses″). The aim of this prospective study was to establish expanded criteria for evaluating the quality of surgical resection in patients undergoing radical retropubic prostatectomy (RRP). METHODS Prospective study (Jan 2005-Dec 2007), 507 consecutive patients with localised prostate cancer underwent RRP. We determined the rate of IPM and PSM. Pathological study: whole-mount 3-mm serial sections using the Stanford technique. Where capsule was absent (apex and bladder neck) no malignant or benign gland must be in contact with the inked margin. In the capsular zone, we defined 1st degree capsule incision (1st DCI): loss of the outer connective tissue layer and 2nd degree capsule incision (2nd DCI): loss of both capsule layers with malignant or benign gland in contact with ink. RESULTS Patient characteristics were mean age 61.3 years; disease stage: pT2 73%, pT3 25.8%; bilateral nerve-sparing n=273, 88.1%, unilateral n=37, 11.9%. The risk of IPM was 5%: incision of benign glandular tissue was 2.8% (apex: 43%; bladder neck: 57%), 1st DCI was 2.2% and 2nd DCI was 0%. The overall PSM rate was 6.3%: 2.2 % (8/370) for pT2, 14.5 % (19/131) for pT3, and 83.3% for pT4. It was 4.8% (15/310) in patients undergoing nerve-sparing surgery. PSM with pT2 tumours occurred at apex (1.7%), postero-lateral 0%, bladder neck (0.5%). PSMs with pT3a/b tumours occurred at: apex (6.1%), postero-lateral (3.8%) and bladder neck (6.9%). PSM size distribution for pT2: PSM≤1 mm: n=4; 1<PSM≤4 mm: n=2; PSM >4 mm: n=2, and for pT3: PSM≤1 mm: n=6; 1<PSM≤4 mm: n=5; PSM>4 mm: n=8. Biochemical recurrence rate (PSA >0.10 ng/ml) at 1 year was 2.6%. CONCLUSIONS The safety of an RP procedure is given not only by the PSM rate for pT2 tumours but also by the percentage of times there is a risk of a PSM. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e600 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Barré Nantes, France More articles by this author Geneviève Aillet Nantes, France More articles by this author Matthieu Thoulouzan Toulouse, France More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...