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

Vipul R. Patel, Rafael F. Coelho, Bernardo Rocco, Marcelo Orvieto, Ananthakrishnan Sivaraman, Kenneth J. Palmer, Darien Kameh, Luigi Santoro, Geoff D. Coughlin, Michael Liss, Wooju Jeong, John Malcolm, Joshua M. Stern, Saurabh Sharma, Kevin C. Zorn, Sergey Shikanov, Arieh L. Shalhav, Gregory P. Zagaja, Thomas E. Ahlering, Koon H. RhaDavid M. Albala, Michael D. Fabrizio, David I. Lee, Sanket Chauhan

Research output: Contribution to journalArticle

87 Citations (Scopus)

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 preoperative 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 (US)
Pages (from-to)511-516
Number of pages6
JournalJournal of Urology
Volume186
Issue number2
DOIs
StatePublished - Aug 2011
Externally publishedYes

Fingerprint

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

Keywords

  • local
  • neoplasm recurrence
  • prostate
  • prostatectomy
  • prostatic neoplasms
  • robotics

ASJC Scopus subject areas

  • 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. Journal of Urology, 186(2), 511-516. https://doi.org/10.1016/j.juro.2011.03.112

Positive surgical margins after robotic assisted radical prostatectomy : A multi-institutional study. / Patel, Vipul R.; Coelho, Rafael F.; Rocco, Bernardo; Orvieto, Marcelo; Sivaraman, Ananthakrishnan; Palmer, Kenneth J.; Kameh, Darien; Santoro, Luigi; Coughlin, Geoff D.; Liss, Michael; Jeong, Wooju; Malcolm, John; Stern, Joshua M.; Sharma, Saurabh; Zorn, Kevin C.; Shikanov, Sergey; Shalhav, Arieh L.; Zagaja, Gregory P.; Ahlering, Thomas E.; Rha, Koon H.; Albala, David M.; Fabrizio, Michael D.; Lee, David I.; Chauhan, Sanket.

In: Journal of Urology, Vol. 186, No. 2, 08.2011, p. 511-516.

Research output: Contribution to journalArticle

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', Journal of Urology, vol. 186, no. 2, pp. 511-516. https://doi.org/10.1016/j.juro.2011.03.112
Patel, Vipul R. ; Coelho, Rafael F. ; Rocco, Bernardo ; Orvieto, Marcelo ; Sivaraman, Ananthakrishnan ; Palmer, Kenneth J. ; Kameh, Darien ; Santoro, Luigi ; Coughlin, Geoff D. ; Liss, Michael ; Jeong, Wooju ; Malcolm, John ; Stern, Joshua M. ; Sharma, Saurabh ; Zorn, Kevin C. ; Shikanov, Sergey ; Shalhav, Arieh L. ; Zagaja, Gregory P. ; Ahlering, Thomas E. ; Rha, Koon H. ; Albala, David M. ; Fabrizio, Michael D. ; Lee, David I. ; Chauhan, Sanket. / Positive surgical margins after robotic assisted radical prostatectomy : A multi-institutional study. In: Journal of Urology. 2011 ; Vol. 186, No. 2. pp. 511-516.
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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 preoperative 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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T1 - Positive surgical margins after robotic assisted radical prostatectomy

T2 - A multi-institutional study

AU - Patel, Vipul R.

AU - Coelho, Rafael F.

AU - Rocco, Bernardo

AU - Orvieto, Marcelo

AU - Sivaraman, Ananthakrishnan

AU - Palmer, Kenneth J.

AU - Kameh, Darien

AU - Santoro, Luigi

AU - Coughlin, Geoff D.

AU - Liss, Michael

AU - Jeong, Wooju

AU - Malcolm, John

AU - Stern, Joshua M.

AU - Sharma, Saurabh

AU - Zorn, Kevin C.

AU - Shikanov, Sergey

AU - Shalhav, Arieh L.

AU - Zagaja, Gregory P.

AU - Ahlering, Thomas E.

AU - Rha, Koon H.

AU - Albala, David M.

AU - Fabrizio, Michael D.

AU - Lee, David I.

AU - Chauhan, Sanket

PY - 2011/8

Y1 - 2011/8

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 preoperative 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 preoperative 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.

KW - local

KW - neoplasm recurrence

KW - prostate

KW - prostatectomy

KW - prostatic neoplasms

KW - robotics

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