Risk-adjusted analysis of positive surgical margins following laparoscopic and retropubic radical prostatectomy Journal Article


Authors: Touijer, K.; Kuroiwa, K.; Eastham, J. A.; Vickers, A.; Reuter, V. E.; Scardino, P. T.; Guillonneau, B.
Article Title: Risk-adjusted analysis of positive surgical margins following laparoscopic and retropubic radical prostatectomy
Abstract: Objectives: To prospectively compare in a contemporary and contemporaneous series the positive surgical margin (PSM) rate between laparoscopic (LRP) and retropubic (RRP) radical prostatectomy at the same institution. Methods: Between 1 January 2003 and 30 June 2005, 1177 consecutive men with clinically localized adenocarcinoma of the prostate underwent radical prostatectomy at the same institution: 485 laparoscopically and 692 through a retropubic approach. Partin table probability of organ-confined (OC) disease was used as an index of disease aggressiveness: The PSM rate between the two approaches was compared, with adjustment for the OC probability. Results: Overall both surgical approaches had a comparable PSM rate of 11.3% after LRP and 11% after RRP. In a logistic regression analysis adjusting for OC probability, there was no statistically significant difference between LRP and RRP (odds ratio [OR]: 1.156; 95% confidence interval [%95 CI], 0.792, 1.686; p = 0.5). There was a statistically significant decrease over time in the rate of PSM for LRP (OR: 0.71 per 100 patients treated; %95 CI, 0.57, 0.89; p = 0.003), while that of RRP was unchanged (OR: 1.06 per 100 patients treated; %95 CI, 0.94, 1.21; p = 0.3; p = 0.002 for interaction between change over time and procedure). Conclusions: In our institution, laparoscopic and retropubic radical prostatectomy provide comparable PSM rates for patients with clinically localized prostate cancer. The PSM rate over the study period remained unchanged in the RRP experience, indicating a mature and well-established operative technique, while that of LRP underwent a significant decrease, demonstrating that the procedure and therefore the results continued to evolve during the study. © 2006.
Keywords: adult; controlled study; treatment outcome; aged; middle aged; surgical technique; retrospective studies; major clinical study; cancer staging; nuclear magnetic resonance imaging; neoplasm staging; laparoscopy; laparoscopic surgery; adenocarcinoma; prostate specific antigen; pathology; surgical approach; risk assessment; prostate cancer; gleason score; prostatic neoplasms; prostatectomy; prostate biopsy; surgery; prostate adenocarcinoma; prostate neoplasms
Journal Title: European Urology
Volume: 52
Issue: 4
ISSN: 0302-2838
Publisher: Elsevier Science, Inc.  
Date Published: 2007-10-01
Start Page: 1090
End Page: 1096
Language: English
DOI: 10.1016/j.eururo.2006.12.014
PUBMED: 17188801
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 22" - "Export Date: 17 November 2011" - "CODEN: EUURA" - "Source: Scopus"
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MSK Authors
  1. Kentaro Kuroiwa
    28 Kuroiwa
  2. Peter T Scardino
    671 Scardino
  3. Karim Abdelkrim Touijer
    259 Touijer
  4. Andrew J Vickers
    882 Vickers
  5. James Eastham
    538 Eastham
  6. Victor Reuter
    1228 Reuter