Risk factors of positive surgical margins after robot-assisted radical prostatectomy in high-volume center: results in 732 cases
The aim of the study was to evaluate clinical, pathological and peri-operative factors associated with the risk of positive surgical margins (PSM) after robot-assisted radical prostatectomy (RARP) in a high-volume center. The study is a retrospective analysis of prospectively collected data. We excluded cases who were under androgen deprivation or had prior treatments. The population included negative cases (control group) and PSM subjects (study groups). The logistic regression model assessed the independent association of factors with the risk of PSM. From January 2013 to December 2017, 732 patients underwent RARP. Extended pelvic lymph node dissection was performed in 342 cases (46.7%). Overall, 192 cases (26.3%) had PSM. Independent factors associated with the risk of focal PSM were body mass index (odds ratio, OR = 0.936; p = 0.021), percentage of biopsy-positive cores (BPC; OR = 1.012; p = 0.004), pathological extracapsular extension (OR = 2.702; p < 0.0001), seminal vesicle invasion (OR = 2.889; p < 0.0001) and high-volume surgeon (OR = 0.607; p = 0.006). In high-volume centers, features related to host, tumor biology and surgeon are independent factors associated with the risk of PSM after RARP, which are decreased by the high-volume surgeon. The inverse association between BMI and PSM risk needs further clinical research. These issues should be discussed when counseling patients.
KeywordsProstate cancer Radical prostatectomy Robotic surgery Positive surgical margins Prostate cancer tumor-grade groups
The authors did not receive a financial support.
Compliance with ethical standards
Conflict of interest
Antonio Benito Porcaro, Marco Sebben, Paolo Corsi, Alessandro Tafuri, Tania Processali, Marco Pirozzi, Nelia Amigoni, Riccardo Rizzetto, Giovanni Cacciamani, Arianna Mariotto, Alberto Diminutto, Matteo Brunelli, Vincenzo De Marco, Salvatore Siracusano and Walter Artibani declare that they have not conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all individual participants included in the study.
- 2.D’Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA, Tomaszewski JE, Renshaw AA, Kaplan I, Beard CJ, Wein A (1999) Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. J Urol 161:1393CrossRefGoogle Scholar
- 11.Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA (2016) The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma: definition of grading patterns and proposal for a new grading system. Am J Surg Pathol 40:244–252Google Scholar
- 14.Montorsi F, Wilson TG, Rosen RC, Ahlering TE, Artibani W, Carroll PR, Costello A, Eastham JA, Ficarra V, Guazzoni G, Menon M, Novara G, Patel VR, Stolzenburg J-U, Van der Poel H, Van Poppel H, Mottrie A (2012) Best practices in robot-assisted radical prostatectomy: recommendations of the Pasadena consensus panel. Eur Urol 62:368–381CrossRefGoogle Scholar
- 20.Srigley JR, Humphrey PA, Amin MB, Chang SS, Egevad L, Epstein JI, Grignon DJ, McKiernan JM, Montironi R, Renshaw AA, Reuter VE, Wheeler TM (2009) Protocol for the examination of specimens from patients with carcinoma of the prostate gland. Arch Pathol Lab Med 133:1568–1576Google Scholar
- 21.Briganti A, Larcher A, Abdollah F, Capitanio U, Gallina A, Suardi N, Bianchi M, Sun M, Freschi M, Salonia A, Karakiewicz PI, Rigatti P, Montorsi F (2012) Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: the essential importance of percentage of positive cores. Eur Urol 61:480–487CrossRefGoogle Scholar
- 22.Porcaro AB, Siracusano S, de Luyk N, Corsi P, Sebben M, Tafuri A, Mattevi D, Bizzotto L, Tamanini I, Cerruto MA, Martignoni G, Brunelli M, Artibani W (2017) Low-risk prostate cancer and tumor upgrading in the surgical specimen: analysis of clinical factors predicting tumor upgrading in a contemporary series of patients who were evaluated according to the modified Gleason score grading system. Curr Urol 10:118–125CrossRefGoogle Scholar
- 23.Porcaro AB, de Luyk N, Corsi P, Sebben M, Tafuri A, Tamanini I, Processali T, Cerruto MA, Migliorini F, Brunelli M, Siracusano S, Artibani W (2017) Bilateral lymph node micrometastases and seminal vesicle invasion associated with same clinical predictors in localized prostate cancer. Tumori 103:299–306CrossRefGoogle Scholar
- 24.Porcaro AB, de Luyk N, Corsi P, Sebben M, Tafuri A, Mattevi D, Processali T, Cerruto MA, Brunelli M, Zecchini Antoniolli S, Siracusano S, Artibani W (2017) Clinical factors predicting and stratifying the risk of lymph node invasion in localized prostate cancer. Urol Int 99:207–214CrossRefGoogle Scholar
- 28.Tholomier C, Bienz M, Hueber PA, Trinh QD, Hakim AE, Alhathal N, Lebeau T, Benayoun S, Valdivieso R, Liberman D, Saad F, Lattouf JB, Widmer H, Begin L, Latour M, Zorn KC (2014) Oncological and functional outcomes of 722 robot-assisted radical prostatectomy (RARP) cases: the largest Canadian 5-year experience. Can Urol Assoc J 8:195–201CrossRefGoogle Scholar
- 29.Rajan P, Hagman A, Sooriakumaran P, Nyberg T, Wallerstedt A, Adding C, Akre O, Carlsson S, Hosseini A, Olsson M, Egevad L, Wiklund F, Steineck G, Wiklund NP (2018) Oncologic outcomes after robot-assisted radical prostatectomy: a large european single-centre cohort with median 10-year follow-up. Eur Urol Focus 4:351–359CrossRefGoogle Scholar
- 30.Antonelli A, Sodano M, Peroni A, Mittino I, Palumbo C, Furlan M, Carobbio F, Tardanico R, Fisogni S, Simeone C (2017) Positive surgical margins and early oncological outcomes of robotic vs open radical prostatectomy at a medium case-load institution. Minerva Urol Nefrol 69:63–68Google Scholar
- 31.Jo JK, Hong SK, Byun SS, Zargar H, Autorino R, Lee SE (2017) Positive surgical margin in robot-assisted radical prostatectomy: correlation with pathology findings and risk of biochemical recurrence. Minerva Urol Nefrol 69:493–500Google Scholar
- 32.Porcaro AB, Tafuri A, Sebben M, Corsi P, Pocessali T, Pirozzi M, Amigoni N, Rizzetto R, Mariotto A, Inverardi D, Brunelli M, Iacovelli R, Romano M, Siracusano S, Artibani W (2018) Positive association between preoperative total testosterone levels and risk of positive surgical margins by prostate cancer: results in 476 consecutive patients treated only by radical prostatectomy. Urol Int 101:38–46CrossRefGoogle Scholar
- 33.Porcaro AB, Sebben M, Tafuri A, de Luyk N, Corsi P, Processali T, Pirozzi M, Rizzetto R, Amigoni N, Mattevi D, Cerruto MA, Brunelli M, Novella G, De Marco V, Migliorini F, Artibani W (2018) Body mass index is an independent predictor of Clavien-Dindo grade 3 complications in patients undergoing robot assisted radical prostatectomy with extensive pelvic lymph node dissection. J Robot Surg 13(1):83–89CrossRefGoogle Scholar
- 34.Moskovic DJ, Lavery HJ, Rehman J, Nabizada-Pace F, Brajtbord J, Samadi DB (2010) High body mass index does not affect outcomes following robotic assisted laparoscopic prostatectomy. Can J Urol 17:5291–5298Google Scholar
- 40.Steinsvik EAS, Axcrona K, Angelsen A, Beisland C, Dahl A, Eri LM, Haug ES, Svindland A, Fosså S (2012) Does a surgeon’s annual radical prostatectomy volume predict the risk of positive surgical margins and urinary incontinence at one-year follow-up?—Findings from a prospective national study. Scand J Urol 47:92–100CrossRefGoogle Scholar