Preoperative and intraoperative risk factors for side-specific positive surgical margins in laparoscopic radical prostatectomy for prostate cancer Journal Article

  

Authors:	Secin, F. P.; Serio, A.; Bianco, F. J. Jr; Karanikolas, N. T.; Kuroiwa, K.; Vickers, A.; Touijer, K.; Guillonneau, B.
Article Title:	Preoperative and intraoperative risk factors for side-specific positive surgical margins in laparoscopic radical prostatectomy for prostate cancer
Abstract:	Objectives: Identification of variables predicting positive surgical margins (PSMs) in patients undergoing laparoscopic radical prostatectomy (LRP) for clinically localized prostate cancer is lacking. Our objective was to determine preoperative risk factors and the association of ipsilateral degree of neurovascular bundle dissection (intraoperative factor) with side-specific PSMs in these patients. Material and methods: Between October 2002 and April 2005, one surgeon performed LRP on 407 previously untreated patients. Of 814 evaluable prostate sides, 728 harboured prostate cancer in the specimen and composed the study population. For each prostate side, we obtained clinical stage, biopsy Gleason, maximum percentage of tumour in the biopsy, suspected extracapsular extension (ECE) on endorectal coil magnetic resonance imaging (MRI), degree of neurovascular bundle (NVB) dissection, and PSMs. PSM was defined as cancer cells at the inked margins. Logistic regression analyses with random effects were generated. Results: Of the 728 prostate sides with cancer, 51 (7%) had at least one PSM. In multivariable analysis, higher PSA (p = 0.01), Gleason score of 7 compared with ≤6 in the biopsy (p = 0.04), lower prostate volume on MRI (p = 0.01), and interfascial NVB dissection compared with intrafascial dissection (p = 0.01) were associated with an increased risk of side-specific PSMs. Suspected ECE on MRI (p = 0.9) and clinical stage (p = 0.3) were not significantly associated with side-specific PSMs. A subset analysis of 321 patients with bilateral tumours did not show statistically significant differences in PSMs according to tumour side (p = 0.3). Conclusions: High serum prostate-specific antigen, biopsy Gleason score of 7, low prostate volume, and interfascial NVB dissection were independently associated with side-specific PSMs after LRP, and should be considered during planning of the LRP surgical strategy. © 2006 European Association of Urology.
Keywords:	treatment outcome; aged; middle aged; major clinical study; treatment planning; cancer staging; nuclear magnetic resonance imaging; laparoscopy; laparoscopic surgery; preoperative evaluation; prostate specific antigen; risk factors; tumor biopsy; dissection; prediction; risk factor; risk assessment; prostate cancer; cancer invasion; gleason score; prostatic neoplasms; intraoperative period; prostatectomy; cancer cell; blood vessel; multivariate analysis; logistic regression analysis; peroperative care; nerve; neurovascular bundle dissection; postive surgical margin
Journal Title:	European Urology
Volume:	51
Issue:	3
ISSN:	0302-2838
Publisher:	Elsevier Science, Inc.
Date Published:	2007-03-01
Start Page:	764
End Page:	771
Language:	English
DOI:	10.1016/j.eururo.2006.10.058
PUBMED:	17098356
PROVIDER:	scopus
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-33846249289&partnerID=40&md5=ee9debcec972d33d27f6595ca18fb684
Notes:	--- - "Cited By (since 1996): 22" - "Export Date: 17 November 2011" - "CODEN: EUURA" - "Source: Scopus"

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