QUALITY IMPROVEMENT IN LAPAROSCOPIC RADICAL PROSTATECTOMY FOR pT2 PROSTATE CANCER: IMPACT OF VIDEO DOCUMENTATION REVIEW ON POSITIVE SURGICAL MARGIN

Touijer, Karim; Kuroiwa, Kentaro; Saranchuk, Jeffery W.; Hassen, Waleed; Trabulsi, Edouard J.; Reuter, Victor E.; Guillonneau, Bertrand

doi:10.1097/01.ju.0000146574.52402.d5

Cited by 60 publications

(31 citation statements)

References 14 publications

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“…Finally, we find of benefit the continuous quality assurance and improvement program, by which pathologic and intraoperative documentation of positive surgical margins are reviewed with the purpose of understanding the factors leading to a surgical margin. This leads to a focus on improving surgical results, particularly in an environment where the standard set by the open radical prostatectomists is high [20].…”

Section: Discussionmentioning

confidence: 99%

“…In parallel, correlation between the results of the whole mount sections of the surgical specimen and the intraoperative findings seen on the video was studied to help understand the mechanism by which a positive surgical margin occurs and to improve our intraoperative detection of the correct plane of dissection in a given patient [20].…”

Section: Quality Improvementmentioning

confidence: 99%

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Impact of a Multidisciplinary Continuous Quality Improvement Program on the Positive Surgical Margin Rate after Laparoscopic Radical Prostatectomy

et al. 2006

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Objective-Outcome after radical prostatectomy is highly sensitive to fine nuances in the surgical techniques. We sought to determine the impact of a process of continuous control and monitoring on the positive surgical margin rate in a contemporary series of laparoscopic radical prostatectomy.Methods-Between January 2003 and October 2004, 301 men underwent laparoscopic radical prostatectomy for clinically localized prostate cancer (cT1-cT3a). A weekly case review conference involving surgeons, radiologists, and uropathologists was held to discuss the preoperative, intraoperative, and pathologic findings of significant cases. We analyzed the trend of positive surgical margins and compared the clinical and detailed pathologic characteristics of the cancer during the study period.Results-We created logistic regression models with positive margin as the dependent variable and surgical experience as the predictor, adjusting for possible secular changes in disease severity (prostate-specific antigen, pathologic stage, and Gleason grade). There was a decrease in the rate of surgical margins: odds ratio 0.68/100 patients treated (95% confidence interval [CI] 0.44, 1.05; p = 0.08). The predicted probability for a positive surgical margin falls from 17.3% for the first patient to 7.5% for the 301st. These values are close to the observed rates for the first and last 50 patients. There was no important change in surgical risk over the course of the study, and the rate of nerve sparing remained stable throughout the study period.Conclusions-In this contemporary series, which is unaffected by downward stage migration, the decreasing rate of positive surgical margins can be explained by subtle surgical technique modifications and a continuous multidepartmental effort for quality improvement.

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Section: Discussionmentioning

confidence: 99%

Section: Quality Improvementmentioning

confidence: 99%

Impact of a Multidisciplinary Continuous Quality Improvement Program on the Positive Surgical Margin Rate after Laparoscopic Radical Prostatectomy

et al. 2006

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“…Several papers have emphasized the importance of surgical margins in LRP and have shown how to reduce positive margin rates. [30][31][32][33] Touijer et al reported that a weekly case review conference involving surgeons, radiologists and uropathologists improved positive margin rates from 17.3% to 7.5%. 33 In another paper, Touijer et al reported that analysis of intraoperative video recordings correlating with pathological findings was helpful to understand the characteristics of positive surgical margins.…”

Section: Discussionmentioning

confidence: 99%

Oncological outcome of laparoscopic prostatectomy

Hara¹,

Kawabata²,

Tanaka³

et al. 2007

Int J of Urology

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Aim: Oncological outcomes including surgical margin status and biological progression-free survival (bPFS) were analyzed in patients who underwent laparoscopic prostatectomy (LRP) only. Methods: A total of 136 patients who underwent LRP only without lymph node metastasis or perioperative supportive therapy between April 2000 and October 2005 were analyzed. All patients received Ն6 months postoperative follow-up. Biological progression was defined as elevation of prostate-specific antigen by >0.2 ng/mL. Results: The positive margin (ew+) rate was 36.8% and the 3-year bPFS was 72.6% for all patients. Positive margin rates in pT2a-b, pT2c, pT3a and pT3b were 10.0%, 27.5%, 77.3% and 53.8%, respectively. Three-year bPFS rates in pT2, pT3a and pT3b were 91.8%, 66.8% and 44.9%, respectively. Although the positive margin rate at posterior and anterior sites decreased as more patients were recruited , no significant improvements were observed at apex and base sites. Three-year bPFS rates in pT2 ew-, pT2 ew+, pT3 ew-and pT3 ew+ were 95.8%, 85.7%, 81% and 48.5%, respectively, indicating that positive margins exert a greater impact in pT3 disease than in pT2 disease. Conclusions: Although 3-year bPFS results were almost identical to previous reports of LRP and retropubic radical prostatectomy, the positive margin rate in pT3a disease was particularly high, probably due to immature surgical skill. Although positive margins at posterior and anterior sites decreased with the leaning curve, improvements are needed to reduce positive margin rates at the apex. Positive margins exert greater impact in pT3 disease than in pT2 disease.

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“…More recently, in 1997, Schuessler et al described the first LRP reporting the feasibility of technique despite its association with long operative times [6]. Since that time, numerous European and US centers continued to improve and refine technical aspects of the laparoscopic approach [7,8].…”

Section: Introductionmentioning

confidence: 99%

Visible Angle on Magnetic Resonance Imaging Can Be Considered Indicator of Postoperative Outcome in Retropubic Radical Prostatectomy

Kwon

Lee

et al. 2017

Korean J Urol Oncol

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Since the introduction of robot-assisted radical prostatectomy (RALP), robotics has become increasingly more commonplace in the armamentarium of the urologic surgeon. Robotic utilization has exploded across surgical disciplines well beyond the fields of urology and prostate surgery. The literature detailing technical steps, comparison of large surgical series, and even robotically focused randomized control trials are available for review. RALP, the first robot-assisted surgical procedure to achieve widespread use, has recently become the primary approach for the surgical management of localized prostate cancer. As a result, surgeons are constantly trying to refine and improve upon current technical aspects of the operation. Recent areas of published modifications include bladder neck anastomosis and reconstruction, bladder drainage, nerve sparing approaches and techniques, and perioperative and postoperative management including penile rehabilitation. In this review, we summarize recent advances in perioperative management and surgical technique for RALP.

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QUALITY IMPROVEMENT IN LAPAROSCOPIC RADICAL PROSTATECTOMY FOR pT2 PROSTATE CANCER: IMPACT OF VIDEO DOCUMENTATION REVIEW ON POSITIVE SURGICAL MARGIN

Abstract: Quality assurance efforts through pathological and intraoperative documentation review can help decrease the positive margin rate, particularly in organ confined disease. However, eradicating positive margins at the distal prostatic apex remains a challenge.

Cited by 60 publications

References 14 publications

Impact of a Multidisciplinary Continuous Quality Improvement Program on the Positive Surgical Margin Rate after Laparoscopic Radical Prostatectomy

Impact of a Multidisciplinary Continuous Quality Improvement Program on the Positive Surgical Margin Rate after Laparoscopic Radical Prostatectomy

Oncological outcome of laparoscopic prostatectomy

Visible Angle on Magnetic Resonance Imaging Can Be Considered Indicator of Postoperative Outcome in Retropubic Radical Prostatectomy

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