A Multinational, Multi-institutional Study Comparing Positive Surgical Margin Rates Among 22 393 Open, Laparoscopic, and Robot-assisted Radical Prostatectomy Patients

Sooriakumaran, Prasanna; Srivastava, Abhishek; Shariat, Shahrokh F.; Stricker, Phillip D.; Ahlering, Thomas E.; Eden, Christopher; Wiklund, Peter; Sánchez-Salas, Rafael; Mottrie, Alexandre; Lee, David I.; Neal, David E.; Ghavamian, Reza; Nyírády, Péter; Nilsson, Andreas; Carlsson, Stefan; Xylinas, Évanguelos; Loidl, Wolfgang; Seitz, Christian; Schramek, Paul; Roehrborn, Claus G.; Cathelineau, Xavier; Skarecky, Douglas; Shaw, Greg; Warren, Anne Y.; Delprado, Warick; Haynes, Anne Marie; Steyerberg, Ewout W.; Roobol, Monique J.; Tewari, Ashutosh

doi:10.1016/j.eururo.2013.11.018

Cited by 124 publications

(90 citation statements)

References 26 publications

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“…The factors associated with a PRM were tumor location, nerve sparing procedure, and tumor diameter. Some studies found that a PRM was associated with nerve sparing and a high-volume center, but the tumor location was not evaluated [14,16]. In our study, the tumor was more common in the apex, and a PRM was highest in the apex.…”

Section: Discussionmentioning

confidence: 46%

“…Among these prognostic factors, resection margin status was important because the PRM rate could be reduced by improvement of the surgical technique. Sooriakumaran et al reported that among 22,393 cases, the PRM of LRP was 16.3%, and that it was better than that of RRP, but was worse than that of RARP [14]. Other reports, including many LRP cases, concluded that the PRM varied from 7.4% to 29.2% [7][8][9][10].…”

Section: Discussionmentioning

confidence: 99%

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Relationship of Positive Resection Margin, Cancer Location and Learning Curve after Laparoscopic Radical Prostatectomy

Hashine¹,

Kakuda²,

Iuchi³

et al. 2017

Med Surg Urol

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Section: Discussionmentioning

confidence: 46%

Section: Discussionmentioning

confidence: 99%

Relationship of Positive Resection Margin, Cancer Location and Learning Curve after Laparoscopic Radical Prostatectomy

Hashine¹,

Kakuda²,

Iuchi³

et al. 2017

Med Surg Urol

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“…For example, Sooriakumaran et al [7] relied on 22,393 PCa patients treated between 2000 and 2011 at 14 different centers of excellence. Of those, 7,697 (34.4%) men were treated with RARP, 4,918 (22.0%) with laparoscopic RP (LARP) and 9,778 (43.6%) with ORP, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Available population-based data demonstrate short-term advantages of RARP relative to ORP, such as fewer blood transfusions, fewer complications and shorter length of hospital stay [5]. Additionally, RARP is at least equivalent [6] if not superior [7] to ORP in terms of margin rates [8]. However, recent data from the United States question long-term functional outcome benefits of RARP over ORP [9].…”

Section: Introductionmentioning

confidence: 99%

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Differences in Patient Characteristics Among Men Choosing Open or Robot-Assisted Radical Prostatectomy in Contemporary Practice at a European High-Volume Center

Schiffmann

Haese²,

Lenz³

et al. 2016

Urol Int

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Objective: To examine the characteristics of robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP) patients at a high-volume center. Patients and Methods: We relied on the Martini-Clinic database and focused on prostate cancer patients treated in 2013. Characteristics in ORP and RARP patients were assessed. In multivariable logistic regression analyses (MVA), we predicted RARP treatment. Results: Of 1,920 patients, 575 (29.9%) underwent RARP and 1,345 (70.1%) ORP. RARP patients had a lower prostate-specific antigen (PSA), and were less likely to harbor pT3b, pathological Gleason ≥4 + 4 or lymph node metastases (all p < 0.05). Pelvic lymph node dissection (PLND) (84.3 vs. 87.0%, p = 0.1), as well as positive surgical margins (15.5 vs. 15.7%, p = 0.7) and the nerve-sparing status (p = 0.5) were comparable between RARP and ORP. Lymph node yield (median 11 vs. 16), and median blood loss (250 vs. 700 ml) were lower at RARP (all p < 0.001). Additionally, the median operating room time was higher at RARP (215 vs. 185 min, p < 0.001). In MVA, patients with body mass index (BMI) ≥30 were more likely to undergo RARP (OR 1.8, 95% CI 1.3-2.4, p < 0.001). Conversely, patients with PSA >20 ng/ml were less likely to undergo RARP (OR 0.6, 95% CI 0.4-1.0, p = 0.03). Conclusions: More favorable pathological characteristics were recorded at RARP. High BMI and low PSA were independent predictors for RARP. Treatment characteristics such as PLND rates, margin status and nerve sparing were comparable between RARP and ORP. Despite lower blood loss at RARP, a longer operating room time and lower yield of lymph nodes were recorded.

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Association of Treatment Facility Characteristics With Overall Survival After Mohs Micrographic Surgery for T1a-T2a Invasive Melanoma

et al. 2021

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elanoma is one of the most common cancers in the US, with 106 110 incident cases estimated to be diagnosed in 2021. 1 Although the standard therapy for localized invasive melanoma is wide local excision, Mohs micrographic surgery (MMS) has been increasingly used as an alternative excisional approach, [2][3][4] with a recent study reporting that 7.9% of surgical melanoma cases in 2016 were excised using MMS. 5 Mohs micrographic surgery offers the advantage of complete margin evaluation during the procedure while potentially limiting healthy tissue removal. Such complete margin evaluation is especially helpful in the case of facial tumors, for which National Comprehensive Cancer Network guidelines state that margins may be reduced for anatomic considerations, or tumors with clinically indistinct borders, such as lentigo maligna melanoma, for which appropriate margins may be difficult to determine clinically. 2,6 Recent work suggests that treatment of early-stage (T1a-T2a category) melanoma with MMS is associated with a modest survival advantage compared with traditional wide local excision. 7 An additional consideration for the more technically complex MMS for melanoma procedure is how effectively it can be applied across centers. Although studies of resections for other cancers have reported that facility-level factors are associated with patient outcomes, it is not yet established how such factors may IMPORTANCE Early-stage melanoma, among the most common cancers in the US, is typically treated with wide local excision. However, recent advances in immunohistochemistry have led to an increasing number of these cases being excised via Mohs micrographic surgery (MMS). Although studies of resections for other cancers have reported that facility-level factors are associated with patient outcomes, it is not yet established how these factors may affect outcomes for patients treated with Mohs micrographic surgery.OBJECTIVE To evaluate the association of treatment center academic affiliation and case volume with long-term patient survival after MMS for T1a-T2a invasive melanoma. DESIGN, SETTING, AND PARTICIPANTSIn a retrospective cohort study, 4062 adults with nonmetastatic, T1a-T2a melanoma diagnosed from 2004 to 2014 and treated with MMS in the National Cancer Database (NCDB) were identified. The NCDB includes all reportable cases from Commission on Cancer-accredited facilities and is estimated to capture approximately 50% of all incident melanomas in the US. Multivariable survival analyses were conducted using Cox proportional hazards models. Data analysis was conducted from February 27 to August 18, 2020. EXPOSURES Treatment facility characteristics.MAIN OUTCOMES AND MEASURES Overall survival. RESULTSThe study population included 4062 patients (2213 [54.5%] men; median [SD] age, 60 [16.3] years) treated at 462 centers. Sixty-two centers were top decile-volume facilities (TDVFs), which treated 1757 patients (61.9%). Most TDVFs were academic institutions (37 of 62 [59.7%]). On multivariable analysis, treatment at an aca...

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A Multinational, Multi-institutional Study Comparing Positive Surgical Margin Rates Among 22 393 Open, Laparoscopic, and Robot-assisted Radical Prostatectomy Patients

Cited by 124 publications

References 26 publications

Relationship of Positive Resection Margin, Cancer Location and Learning Curve after Laparoscopic Radical Prostatectomy

Relationship of Positive Resection Margin, Cancer Location and Learning Curve after Laparoscopic Radical Prostatectomy

Differences in Patient Characteristics Among Men Choosing Open or Robot-Assisted Radical Prostatectomy in Contemporary Practice at a European High-Volume Center

Association of Treatment Facility Characteristics With Overall Survival After Mohs Micrographic Surgery for T1a-T2a Invasive Melanoma

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