The association of a risk group with positive margin in the intraoperative and final pathology examination after robotic radical prostatectomy.

Abstract

IntroductionThe aim of this study was to evaluate the risk of a positive margin in the intraoperative and final pathology depending on the risk group for biochemical recurrence in biopsy specimens after robot-assisted radical prostatectomy (RaRP) with sparing of the neurovascular bundles (NS).Material and methodsThe study was prospective and non-randomised. The intraoperative and final pathology examinations were performed in 65 consecutive patients treated with RaRP between 11.2019–08.2020. In the intraoperative examination, the site of the dissected neurovascular bundles and any suspicious places were examined. Patients were divided into 3 risk groups [according to the European Association of Urology (EAU) biochemical recurrence-risk stratification]. Due to the uncertain prognostic value of microscopic positive margins, 3 groups were identified: R0, Rmicro and R1.ResultsIn the intraoperative examination, the distribution of risk groups in R0, Rmicro and R1 groups is similar (p = 0.132). In the postoperative study, the distribution of risk groups in each margin group is different, and is statistically significant (p <0.001). It has been shown that an increase in the risk group is an indicator of the occurrence of a positive margin in the final histopathological result regardless of the inclusion of Rmicro into R1 or into R0 by 2.68 and 6.52 times, respectively.ConclusionsThe preoperative risk group is an important factor for the occurrence of a positive margin, but only in the final examination and not in the intraoperative one. An intraoperative examination of the neurovascular bundles only is pointless and should be extended to the examination of the apex.