1791 IMPACT OF POSITIVE SURGICAL MARGINS ON CLINICAL OUTCOME FOLLOWING LAPAROSCOPIC RADICAL PROSTATECTOMY (LRP)–LONG TERM RESULTS

Abstract

You have accessJournal of UrologyProstate Cancer: Localized1 Apr 20111791 IMPACT OF POSITIVE SURGICAL MARGINS ON CLINICAL OUTCOME FOLLOWING LAPAROSCOPIC RADICAL PROSTATECTOMY (LRP)–LONG TERM RESULTS Jonas Busch, Carsten Stephan, Carsten Kempkensteffen, Stefan Hinz, Annett Klutzny, Steffen Weikert, Kurt Miller, and Ahmed Magheli Jonas BuschJonas Busch Berlin, Germany More articles by this author , Carsten StephanCarsten Stephan Berlin, Germany More articles by this author , Carsten KempkensteffenCarsten Kempkensteffen Berlin, Germany More articles by this author , Stefan HinzStefan Hinz Berlin, Germany More articles by this author , Annett KlutznyAnnett Klutzny Berlin, Germany More articles by this author , Steffen WeikertSteffen Weikert Berlin, Germany More articles by this author , Kurt MillerKurt Miller Berlin, Germany More articles by this author , and Ahmed MagheliAhmed Magheli Berlin, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2141AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The role of positive surgical margins (PSM) in prostatectomy specimens for the prediction of biochemical recurrence (BCR) has been heavily debated in the medical literature. It is a general conception that PSM are an adverse finding. However, especially in LRP, on intermediate-term follow up, PSM have been shown to have a limited influence on BCR. The aim of this study was to investigate the impact of PSM on clinical outcome following LRP in patients with extended follow up. METHODS We reviewed the records of 1,920 patients who underwent LRP from 1999 to 2007. Clinical outcome of patients with and without PSM was compared using the log rank test. The independent predictive value of PSM on outcome when taking into account other predictors of BCR was investigated by Cox regression analysis. RESULTS Overall, 447 (23.3%) patients had a positive surgical margin. Mean postoperative follow up was 60.5 months. BCR-free survival at 10 years was 77 % and 54% for patients with and without PSM, respectively (p<0.001). On univariate Cox-regression analysis, radical prostatectomy Gleason score (p<0.001), surgical margin status (p<0.001), pathological stage (p<0.001), and PSA (p<0.001) were predictors of biochemical recurrence. On multivariable Cox-regression analysis, including all statistical significant variables from the univariate model, PSA (p=0.012), pathological stage (p<0.001), radical prostatectomy Gleason score (p<0.001) and surgical margin status (p=0.016) remained independent predictors of BCR. CONCLUSIONS In contrast to other investigators who showed a limited impact of surgical margin status on BCR rates in patients undergoing LRP, we demonstrated its independent predictive value for BCR in our large cohort of LRP patients with extended follow-up. This underlines the importance of meticulous surgical dissection in minimally-invasive prostate surgery to reduce positive surgical margins. Our results could potentially be transferred to robotic assisted RP, in which long-term follow-up is lacking. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e719-e720 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonas Busch Berlin, Germany More articles by this author Carsten Stephan Berlin, Germany More articles by this author Carsten Kempkensteffen Berlin, Germany More articles by this author Stefan Hinz Berlin, Germany More articles by this author Annett Klutzny Berlin, Germany More articles by this author Steffen Weikert Berlin, Germany More articles by this author Kurt Miller Berlin, Germany More articles by this author Ahmed Magheli Berlin, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...