Positive surgical margins after robotic assisted radical prostatectomy: A multi-institutional study

V. R. Patel, R. F. Coelho, B. Rocco, M. Orvieto, A. Sivaraman, K. J. Palmer, D. Kameh, L. Santoro, G. D. Coughlin, M. Liss, W. Jeong, J. Malcolm, J. M. Stern, S. Sharma, K. C. Zorn, S. Shikanov, A. L. Shalhav, G. P. Zagaja, T. E. Ahlering, K. H. RhaD. M. Albala, M. D. Fabrizio, D. I. Lee, S. Chauhan

Research output: Contribution to journalComment/debate

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 preoper ative 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.

Original languageEnglish
Pages (from-to)540-541
Number of pages2
JournalInternational Braz J Urol
Volume37
Issue number4
DOIs
Publication statusPublished - 2011 Jul 1

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Robotics
Prostatectomy
Prostate-Specific Antigen
Margins of Excision
Prostate
Body Mass Index
Multivariate Analysis
Logistic Models
Weights and Measures
Neoplasm Grading
Urinary Bladder
Biopsy

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Patel, V. R., Coelho, R. F., Rocco, B., Orvieto, M., Sivaraman, A., Palmer, K. J., ... Chauhan, S. (2011). Positive surgical margins after robotic assisted radical prostatectomy: A multi-institutional study. International Braz J Urol, 37(4), 540-541. https://doi.org/10.1590/S1677-55382011000400017
Patel, V. R. ; Coelho, R. F. ; Rocco, B. ; Orvieto, M. ; Sivaraman, A. ; Palmer, K. J. ; Kameh, D. ; Santoro, L. ; Coughlin, G. D. ; Liss, M. ; Jeong, W. ; Malcolm, J. ; Stern, J. M. ; Sharma, S. ; Zorn, K. C. ; Shikanov, S. ; Shalhav, A. L. ; Zagaja, G. P. ; Ahlering, T. E. ; Rha, K. H. ; Albala, D. M. ; Fabrizio, M. D. ; Lee, D. I. ; Chauhan, S. / Positive surgical margins after robotic assisted radical prostatectomy : A multi-institutional study. In: International Braz J Urol. 2011 ; Vol. 37, No. 4. pp. 540-541.
@article{76c2a12f1c43469987464adfd081869a,
title = "Positive surgical margins after robotic assisted radical prostatectomy: A multi-institutional study",
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 preoper ative 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.",
author = "Patel, {V. R.} and Coelho, {R. F.} and B. Rocco and M. Orvieto and A. Sivaraman and Palmer, {K. J.} and D. Kameh and L. Santoro and Coughlin, {G. D.} and M. Liss and W. Jeong and J. Malcolm and Stern, {J. M.} and S. Sharma and Zorn, {K. C.} and S. Shikanov and Shalhav, {A. L.} and Zagaja, {G. P.} and Ahlering, {T. E.} and Rha, {K. H.} and Albala, {D. M.} and Fabrizio, {M. D.} and Lee, {D. I.} and S. Chauhan",
year = "2011",
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language = "English",
volume = "37",
pages = "540--541",
journal = "International braz j urol : official journal of the Brazilian Society of Urology",
issn = "1677-5538",
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}

Patel, VR, Coelho, RF, Rocco, B, Orvieto, M, Sivaraman, A, Palmer, KJ, Kameh, D, Santoro, L, Coughlin, GD, Liss, M, Jeong, W, Malcolm, J, Stern, JM, Sharma, S, Zorn, KC, Shikanov, S, Shalhav, AL, Zagaja, GP, Ahlering, TE, Rha, KH, Albala, DM, Fabrizio, MD, Lee, DI & Chauhan, S 2011, 'Positive surgical margins after robotic assisted radical prostatectomy: A multi-institutional study', International Braz J Urol, vol. 37, no. 4, pp. 540-541. https://doi.org/10.1590/S1677-55382011000400017

Positive surgical margins after robotic assisted radical prostatectomy : A multi-institutional study. / Patel, V. R.; Coelho, R. F.; Rocco, B.; Orvieto, M.; Sivaraman, A.; Palmer, K. J.; Kameh, D.; Santoro, L.; Coughlin, G. D.; Liss, M.; Jeong, W.; Malcolm, J.; Stern, J. M.; Sharma, S.; Zorn, K. C.; Shikanov, S.; Shalhav, A. L.; Zagaja, G. P.; Ahlering, T. E.; Rha, K. H.; Albala, D. M.; Fabrizio, M. D.; Lee, D. I.; Chauhan, S.

In: International Braz J Urol, Vol. 37, No. 4, 01.07.2011, p. 540-541.

Research output: Contribution to journalComment/debate

TY - JOUR

T1 - Positive surgical margins after robotic assisted radical prostatectomy

T2 - A multi-institutional study

AU - Patel, V. R.

AU - Coelho, R. F.

AU - Rocco, B.

AU - Orvieto, M.

AU - Sivaraman, A.

AU - Palmer, K. J.

AU - Kameh, D.

AU - Santoro, L.

AU - Coughlin, G. D.

AU - Liss, M.

AU - Jeong, W.

AU - Malcolm, J.

AU - Stern, J. M.

AU - Sharma, S.

AU - Zorn, K. C.

AU - Shikanov, S.

AU - Shalhav, A. L.

AU - Zagaja, G. P.

AU - Ahlering, T. E.

AU - Rha, K. H.

AU - Albala, D. M.

AU - Fabrizio, M. D.

AU - Lee, D. I.

AU - Chauhan, S.

PY - 2011/7/1

Y1 - 2011/7/1

N2 - 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 preoper ative 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.

AB - 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 preoper ative 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.

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U2 - 10.1590/S1677-55382011000400017

DO - 10.1590/S1677-55382011000400017

M3 - Comment/debate

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VL - 37

SP - 540

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JO - International braz j urol : official journal of the Brazilian Society of Urology

JF - International braz j urol : official journal of the Brazilian Society of Urology

SN - 1677-5538

IS - 4

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