Surgical margin length and location affect recurrence rates after robotic prostatectomy

Dev, Harveer; Wiklund, Peter; Patel, Vipul; Parashar, Deepak; Palmer, Kenneth J.; Nyberg, Tommy; Skarecky, Doug; Neal, David E.; Ahlering, T.; Sooriakumaran, Prasanna

doi:10.1016/j.urolonc.2014.11.005

Cited by 69 publications

(67 citation statements)

References 33 publications

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“…The MRI group experienced a lower rate of PSMs in the ventral apex (Fig. 3), although the prognostic value of this is controversial [23,24].…”

Section: Importance Of the Index Tumour And Positive Surgical Marginsmentioning

confidence: 99%

“…Previously performed MRI (112) Contraindications to MRI (23) Did not wish to participate (10) Treated at other hospital (9) Unknown (35) Patients included for intention-to-treat analysis (n = 222) Underwent MRI (203) Did not undergo MRI (19) Contraindications to MRI (5) Change in surgical date (6) Did not meet (3) Other (6) MRI (n = 245)…”

Section: Excluded ( N = 189)mentioning

confidence: 99%

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Does Preoperative Magnetic Resonance Imaging Reduce the Rate of Positive Surgical Margins at Radical Prostatectomy in a Randomised Clinical Trial?

et al. 2015

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“…The MRI group experienced a lower rate of PSMs in the ventral apex (Fig. 3), although the prognostic value of this is controversial [23,24].…”

Section: Importance Of the Index Tumour And Positive Surgical Marginsmentioning

confidence: 99%

Section: Excluded ( N = 189)mentioning

confidence: 99%

Does Preoperative Magnetic Resonance Imaging Reduce the Rate of Positive Surgical Margins at Radical Prostatectomy in a Randomised Clinical Trial?

et al. 2015

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“…Recently, we reported the negative impact of PSM in patients with organ‐confined or nonorgan confined PCa on cancer‐specific survival within the Surveillance, Epidemiology, and End Results database . Moreover, several others reported the negative impact of PSM on biochemical recurrence (BCR) in organ‐confined PCa after RP …”

Section: Introductionmentioning

confidence: 99%

Impact of positive surgical margin length and Gleason grade at the margin on biochemical recurrence in patients with organ‐confined prostate cancer

et al. 2019

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Background Positive surgical margins (PSMs) represent a poor prognostic factor at radical prostatectomy (RP). To investigate the impact of PSM, its length, the focality, and the PSM Gleason, on biochemical recurrence (BCR) in organ‐confined RP patients. Methods Within a high‐volume center database, we identified patients who harbored organ‐confined (pathologic stage T2 disease) prostate cancer (PCa) at RP (2010‐2016). Kaplan‐Meier analyses and multivariable Cox regression models were used to test the effect of the PSM on the BCR risk. Results Overall, 8770 patients were identified. Of those, 6.6% (n = 579) harbored PSM. BCR‐free survival at 72 months after RP was 77.7% vs 89.0% for patients with vs without PSM (P < .001). BCR‐free survival rates at 72 months were 77.4% vs 73.6% (P = .1) for unifocal vs multifocal PSM, 77.2% vs 71.8% (P = .03) for Gleason pattern 3 vs ≥4 at the margin and 88.4% vs 66.3% (P < .001) for <3 vs ≥3 mm length of margin. In multivariable Cox models PSM was an independent predictor for BCR (hazard ratio [HR] = 2.40, P < .001). However, in subgroups with PSM, only ≥3 mm PSM represented an independent predictor (HR = 1.93, P = .04), while focality and Gleason at the margin were no significant predictors. Conclusion PSM represents an independent predictor for BCR in organ‐confined PCa at RP. Moreover, Gleason ≥4 at the margin and ≥3 mm PSM length were associated with worse BCR‐free survival. Closer surveillance of patients with organ‐confined PCa at RP and PSM can help to identify those who qualify for early salvage radiotherapy.

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“…Using a Mohs technique would make the process of examining the surgical margins less resource‐intensive but the wider question is whether the examination is of any benefit to the oncological outcome of radical prostatectomy. The impact of positive surgical margins appears to be significant with an involved margin of >3 mm , and this seems to tally with the finding that, in only 23% of the Schlomm series and 42% of Mirmilstein series , patients with positive NeuroSAFE frozen sections had tumour in the subsequently excised extraprostatic tissue. Patients with positive frozen sections, but negative extraprostatic tissue are classified as having pT2 rather than pT3a disease, although of course they may be upstaged by extraprostatic extension elsewhere, for example, the bladder neck.…”

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confidence: 68%

Could a Mohs technique make NeuroSAFE a viable option?

2018

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Surgical margin length and location affect recurrence rates after robotic prostatectomy

Cited by 69 publications

References 33 publications

Does Preoperative Magnetic Resonance Imaging Reduce the Rate of Positive Surgical Margins at Radical Prostatectomy in a Randomised Clinical Trial?

Does Preoperative Magnetic Resonance Imaging Reduce the Rate of Positive Surgical Margins at Radical Prostatectomy in a Randomised Clinical Trial?

Impact of positive surgical margin length and Gleason grade at the margin on biochemical recurrence in patients with organ‐confined prostate cancer

Could a Mohs technique make NeuroSAFE a viable option?

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