Location of positive surgical margins after retropubic, perineal, and laparoscopic radical prostatectomy for organ-confined prostate cancer

Salomon, Laurent; Anastasiadis, Aristotelis G.; Levrel, Olivier; Katz, Ran; Saint, F.; Taille, Alexandre de la; Cicco, Antony; Vordos, Dimitri; Hoznek, Andràs; Chopin, Dominique; Abbou, C.C.

doi:10.1016/s0090-4295(02)02255-0

Cited by 98 publications

(57 citation statements)

References 26 publications

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“…Salomon et al 16,17 showed in a retrospective analysis of 538 consecutive cases, that a positive surgical margin at the apex was associated with worse clinical prognosis compared to bladder neck or posterolateral locations. He also made clear that the apex of the prostate is a specific high-risk location specifically in retropubic approach.…”

Section: Discussionmentioning

confidence: 99%

Improved urinary continence after radical retropubic prostatectomy with preparation of a long, partially intraprostatic portion of the membraneous urethra: an analysis of 1013 consecutive cases

Randenborgh

Paul

Kübler

et al. 2004

Prostate Cancer Prostatic Dis

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Purpose: To improve the rate of full continence in our patients, we performed, since June 1997, a careful preparation of the distally intraprostatic part of the membranous urethra to obtain a long urethral stump for the vesicourethral anastomosis. Patients and methods: In all, 610 patients without (group 1) and 403 patients with (group 2) a long intraprostatic stump of the urethra were asked by a selfadministered questionnaire about their continence status. The rate of positive surgical margins were compared as a marker of local tumour control. Results: Full continence (no pads) was achieved in 76.02% in group 1 and in 88.84%, of all patients in group 2. Stress incontinence (SIC) I1 was found in 12.46% and 7.44% respectiveley, SIC II1 was noted in 8.69 and 3.72% and complete incontinence was seen in 2.79% in group 1 and in two patients (0.5%) in group 2. Also the time to reach the final continence status was statistically and highly significantly (Po0.001) shortened. The rate of positive margins decreased in group 2, despite intraprostatic preparation. Conclusions: The preparation of a long, partially intraprostatic portion of the membranous urethra for vesicourethral anastomosis in radical retropubic prostatectomy leads to a statistically highly significant improvement of full continence and earlier continence in prostate cancer patients without compromising local tumour control.

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Section: Discussionmentioning

confidence: 99%

Improved urinary continence after radical retropubic prostatectomy with preparation of a long, partially intraprostatic portion of the membraneous urethra: an analysis of 1013 consecutive cases

Randenborgh

Paul

Kübler

et al. 2004

Prostate Cancer Prostatic Dis

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“…3 The surgical approach has also been found to impact on the likelihood of location-specific margin positivity, with perineal access being more frequently associated with anterior and bladder neck positive margins, when compared with a retropubic approach. 22 Further, Smith et al 23 found that the most common location of a positive surgical margin in robotic-assisted laparoscopic and retropubic radical prostatectomy was at the apex. Inter-institutional variation in the specific classification of margins, in particular the circumferential ones, makes it difficult to compare the location of positive margins in radical prostatectomy specimens in various reported series.…”

Section: Location Of Positive Surgical Marginsmentioning

confidence: 99%

International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 5: surgical margins

et al. 2011

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The 2009 International Society of Urological Pathology Consensus Conference in Boston, made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to surgical margin assessment were coordinated by working group 5. Pathologists agreed that tumor extending close to the 'capsular' margin, yet not to it, should be reported as a negative margin, and that locations of positive margins should be indicated as either posterior, posterolateral, lateral, anterior at the prostatic apex, mid-prostate or base. Other items of consensus included specifying the extent of any positive margin as millimeters of involvement; tumor in skeletal muscle at the apical perpendicular margin section, in the absence of accompanying benign glands, to be considered organ confined; and that proximal and distal margins be uniformly referred to as bladder neck and prostatic apex, respectively. Grading of tumor at positive margins was to be left to the discretion of the reporting pathologists. There was no consensus as to how the surgical margin should be regarded when tumor is present at the inked edge of the tissue, in the absence of transected benign glands at the apical margin. Pathologists also did not achieve agreement on the reporting approach to benign prostatic glands at an inked surgical margin in which no carcinoma is present.

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“…The first consistent series of NS laparoscopic radical prostatectomy have shown Nerve-sparing radical retropubic prostatectomy P Gontero and RS Kirby outcomes comparable to open surgery so far. 78,79 A comparative study of open and laparoscopic radical prostatectomy has shown overlapping results for PSM (7.3 vs 7.8%) and potency rates (65 vs 55%). 80 As yet we do not know if the laparoscopic technique has reached its zenith or whether it will continue to improve, perhaps with the assistance of the robot.…”

Section: The Challenge Of the Futurementioning

confidence: 99%

Nerve-sparing radical retropubic prostatectomy: techniques and clinical considerations

Gontero

Kirby

2005

Prostate Cancer Prostatic Dis

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There are essentially two ways to accomplish nerve preservation during radical retropubic prostatectomy: the 'apical approach' described by Walsh and the so-called 'lateral approach', a simplified method where the dissection is initially conducted on the portion of the bundles that courses posterolateral to the prostate. Do the different techniques differ in the ability to preserve potency and in the positive surgical margins rate? No previous study has addressed this question. Above all, the preoperative and intraoperative indications to spare or not the nerves remain a matter of debate. The present review is an attempt to elucidate these questions in light of the current literature.

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Location of positive surgical margins after retropubic, perineal, and laparoscopic radical prostatectomy for organ-confined prostate cancer

Cited by 98 publications

References 26 publications

Improved urinary continence after radical retropubic prostatectomy with preparation of a long, partially intraprostatic portion of the membraneous urethra: an analysis of 1013 consecutive cases

Improved urinary continence after radical retropubic prostatectomy with preparation of a long, partially intraprostatic portion of the membraneous urethra: an analysis of 1013 consecutive cases

International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 5: surgical margins

Nerve-sparing radical retropubic prostatectomy: techniques and clinical considerations

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