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

Touijer, Karim; Kuroiwa, Kentaro; Vickers, Andrew J.; Reuter, Victor E.; Hricak, Hedvig; Scardino, Peter T.; Guillonneau, Bertrand

doi:10.1016/j.eururo.2005.12.065

Cited by 39 publications

(7 citation statements)

References 33 publications

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“…The positive margin rates of 49% and 41% in group 1 and 2, respectively, initially appear to be higher than rates in the present urological context [18–23]. However, other international studies conducted during a similar period to that used here (1991–2001) reflected positive margin rates similar to those in the present analyses [24–29].…”

Section: Discussionsupporting

confidence: 67%

Stage migration in localized prostate cancer has no effect on the post‐radical prostatectomy Kattan nomogram

Thanigasalam¹,

Rasiah²,

Stricker³

et al. 2010

BJU International

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Study Type – Prognosis (case series) Level of Evidence 4 OBJECTIVE To investigate the effect of prostate‐specific antigen (PSA) testing on stage migration in an Australian population, and its consequences on the prognostic accuracy of the post‐radical prostatectomy (RP) Kattan nomogram, as in North America widespread PSA testing has resulted in prostate cancer stage migration, questioning the utility of prognostic nomograms in this setting. PATIENTS AND METHODS The study comprised 1008 men who had consecutive RP for localized prostate cancer between 1991 and 2001 at one institution. Two groups were assessed, i.e. those treated in 1991–96 (group 1, the early PSA era), and 1997–2001 (group 2, the contemporary PSA era). Differences in clinicopathological features between the groups were analysed by chi‐squared testing and survival modelling. Individual patient data were entered into the post‐RP Kattan nomogram and the efficacy assessed by receiver‐ operating characteristic curve analysis. RESULTS Patients in group 2 had lower pathological stage disease (P = 0.01) and fewer cancers with Gleason score ≥8 (P < 0.001) than group 1. Multivariate analysis identified preoperative serum PSA level (P < 0.01) and Gleason score (P < 0.01) as strong predictors of biochemical relapse in both groups. In group 2 pathological stage was not significant, but margin involvement became highly significant (P = 0.004). There was no difference in the predictive accuracy of the Kattan nomogram between the groups (P = 0.253). CONCLUSIONS These findings show a downward stage migration towards organ‐confined disease after the introduction of widespread PSA testing in an Australian cohort. Despite this, the Kattan nomogram remains a robust prognostic tool in clinical practice.

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Section: Discussionsupporting

confidence: 67%

Stage migration in localized prostate cancer has no effect on the post‐radical prostatectomy Kattan nomogram

Thanigasalam¹,

Rasiah²,

Stricker³

et al. 2010

BJU International

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“…13 Other strategies to improve LRP outcomes are the correlation of intraoperative video recordings with pathology findings to understand how PSMs occurred, plus an institutional multi-departmental process of continued evaluation of surgical technique and outcomes. 14,15 …”

Section: Discussionmentioning

confidence: 99%

The Learning Curve for Laparoscopic Radical Prostatectomy: An International Multicenter Study

et al. 2010

Self Cite

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Purpose It is not yet possible to estimate the number of cases required for a beginner to become expert in laparoscopic radical prostatectomy. We estimated the learning curve of laparoscopic radical prostatectomy for positive surgical margins compared to a published learning curve for open radical prostatectomy. Materials and Methods We reviewed records from 8,544 consecutive patients with prostate cancer treated laparoscopically by 51 surgeons at 14 academic institutions in Europe and the United States. The probability of a positive surgical margin was calculated as a function of surgeon experience with adjustment for pathological stage, Gleason score and prostate specific antigen. A second model incorporated prior experience with open radical prostatectomy and surgeon generation. Results Positive surgical margins occurred in 1,862 patients (22%). There was an apparent improvement in surgical margin rates up to a plateau at 200 to 250 surgeries. Changes in margin rates once this plateau was reached were relatively minimal relative to the CIs. The absolute risk difference for 10 vs 250 prior surgeries was 4.8% (95% CI 1.5, 8.5). Neither surgeon generation nor prior open radical prostatectomy experience was statistically significant when added to the model. The rate of decrease in positive surgical margins was more rapid in the open vs laparoscopic learning curve. Conclusions The learning curve for surgical margins after laparoscopic radical prostatectomy plateaus at approximately 200 to 250 cases. Prior open experience and surgeon generation do not improve the margin rate, suggesting that the rate is primarily a function of specifically laparoscopic training and experience.

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“…Patients with positive tumor margins following radical prostatectomy are reported to be more likely to develop biological, local and systemic progression. [34] About 50% of these patients experience recurrence; so it is an urgent need to explore predictive biomarkers in this subgroup. [35] In the subgroup analysis defined by surgical margin status, PITX2 methylation status was also shown to be a robust predictor for BCR risk in patients with tumor involvement of surgical margins, and this finding may help develop a risk-adjusted approach to adjuvant therapy after radical prostatectomy for those patients.…”

Section: Discussionmentioning

confidence: 99%

PITX2 methylation: a novel and effective biomarker for monitoring biochemical recurrence risk of prostate cancer

Jiang¹,

Xie

He³

et al. 2019

Medicine

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Aims:Prostate cancer is one of the most common malignancies in men. Biochemical recurrence (BCR) and progression following curative treatment pose a significant public health challenge. Thus, it is essential to explore effective biomarkers for disease progression monitoring and risk stratification. The promoter region of the paired-like homeodomain transcription factor 2 (PITX2) gene has been found to be frequently methylated in prostate cancer. However, the prognostic role of PITX2 methylation in prostate cancer and which patients most likely to be recommended for PITX2 methylation tests to assess BCR risk remain controversial. Therefore, a systematic review was performed to explore the relationship of PITX2 methylation with the BCR risk of prostate cancer.Methods:The PubMed, EMBASE, and Cochrane Library databases were systematically searched for eligible studies. Seven studies with a total of 2185 patients were included. Pooled hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were calculated.Results:The overall HR was 2.71 (95% CI, 2.21–3.31), suggesting that PITX2 methylation has an adverse impact on BCR of prostate cancer. The pooled estimate of 5-year BCR-free survival for patients with a high methylation status was significantly lower than that for patients with a low methylation status (71% vs 90%; odds ratio [OR] = 3.50; 95% CI, 2.67–4.60, P = .000). A subgroup analysis was conducted according to detection method; the combined HRs were 2.68 (95% CI, 2.02–3.55) for quantitative methylation-specific PCR (qMSP) and 3.29 (95% CI, 2.31–4.68) for microarray EpiChip. In subgroups defined by region, Gleason score, pathological stage, surgical margin status and ethnicity, high methylation status was also associated with BCR of prostate cancer.Conclusions:As an effective biomarker, PITX2 methylation is feasible for individualized BCR risk assessment of prostate cancer following radical prostatectomy.

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

Cited by 39 publications

References 33 publications

Stage migration in localized prostate cancer has no effect on the post‐radical prostatectomy Kattan nomogram

Stage migration in localized prostate cancer has no effect on the post‐radical prostatectomy Kattan nomogram

The Learning Curve for Laparoscopic Radical Prostatectomy: An International Multicenter Study

PITX2 methylation: a novel and effective biomarker for monitoring biochemical recurrence risk of prostate cancer

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