Significant reduction in positive surgical margin rate after laparoscopic radical prostatectomy by application of the modified surgical margin recommendations of the 2009 International Society of Urological Pathology consensus

Maxeiner, Andreas; Magheli, Ahmed; Jöhrens, Korinna; Kilic, Ergin; Braun, T; Kempkensteffen, Carsten; Hinz, Stefan; Stephan, Carsten; Miller, Kurt; Busch, Jonas

doi:10.1111/bju.13451

Cited by 11 publications

(9 citation statements)

References 35 publications

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“…It should, however, be noted that their study included patients classified N+ and/or pT3b, which could be confounding factors in the BR assessment. Similarly, Maxeiner et al [16] reported that multiple PSM and those > 3 mm represented an independent BR factor, whereas these authors likewise included patients with potential confounding factors (N+, PT3b, PT4, or neoadjuvant treatment).…”

Section: Introductionmentioning

confidence: 99%

Extent of positive surgical margins following radical prostatectomy: impact on biochemical recurrence with long-term follow-up

et al. 2019

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Background To assess the prognostic value of the extent of positive surgical margins (PSM) following radical prostatectomy (RP) on biochemical recurrence (BR) with long-term follow-up. Methods This retrospective study analyzed 1275 RPs performed between January 1992 and December 2013 in two university centers in Marseille (France). The inclusion criteria were: follow-up > 24 months, undetectable postoperative prostate-specific antigen (PSA), no seminal vesicle (SV) invasion, no lymph node invasion confirmed by surgery (pN0) or imaging (pNx), and no neoadjuvant or adjuvant treatment. BR was defined by PSA level ≥ 0.2 ng/mL on two successive samples. We included 189 patients, divided into two groups: - Focal PSM (fPSM): single PSM (sPSM) ≤3 mm; - Extensive PSM (ePSM): sPSM with linear length > 3 mm or several margins regardless of the length. Results The median follow-up was 101 months (18–283) and the median age was 63 years (46–76). BR occurred in only 12.1% (14/115) of cases involving fPSM and in 54.1% (40/74) of cases involving ePSM. In the multivariate model, ePSM patients were significantly associated with increased BR compared to fPSM (hazard ratio [HR] = 6.11; 95% confidence interval [CI] = 3.25–11.49). The ePSM significantly decreased BR-free survival ( p < 0.001) for every patient and every subgroup (pT2, pT3a, pG ≤6, and pG ≥7). The median BR time following RP was significantly shorter for ePSM patients than fPSM (57.2 vs. 89.2 months p < 0.001). Conclusion With a median 8-year follow-up, ePSM was strongly associated with BR compared to fPSM. Therefore, it seems legitimate to monitor patients with fPSM. In cases of ePSM, adjuvant treatment appears effective.

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Section: Introductionmentioning

confidence: 99%

Extent of positive surgical margins following radical prostatectomy: impact on biochemical recurrence with long-term follow-up

et al. 2019

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“…Recent studies [27, 28] demonstrated that patients with PSMs have a higher risk of BCR and clinical progression but not necessarily of cancer-specific mortality. At a median follow-up of 92 months (IQR, 87–99), our BCR rate was 30% and cancer-specific mortality was 2%, both of which are within the range reported in recent studies [3–6, 8, 14, 16–18, 29].…”

Section: Discussionmentioning

confidence: 99%

“…Our findings explain this controversy, which is likelydue to lack of distinction between focal and extensive PSMs at the apex. This further demonstrates the importance of adopting a standard method to report PSMs, including their precise extent and location [28]. The finding that focal apical PSMs are not associated with BCR is important, as it could help surgeons improve functional outcomes by sparing the sphincter, and could improve prognosis and decisions regarding additional radiotherapy (RT) [1, 2, 9].…”

Section: Discussionmentioning

confidence: 99%

“…For the total cohort of 530 patients, PSMs were observed in 156 (29%) patients, of which 18 had two or more PSMs. The incidence of PSMs reported in recent radical prostatectomy series varies widely (12–35%) [3–6, 8, 14, 16–18, 29], partly due to the large inter-observer variability in identifying PSMs [28], and is also related to surgical experience [3, 6, 9, 12, 13]. For instance, in their study of 1701 RALPs, Sivaraman et al [6] described a sharp decrease of PSM incidence from 25 to 20% after the first 350 patients.…”

Section: Discussionmentioning

confidence: 99%

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Risk of biochemical recurrence based on extent and location of positive surgical margins after robot-assisted laparoscopic radical prostatectomy

et al. 2018

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BackgroundThere are no published studies on the simultaneous effect of extent and location of positive surgical margins (PSMs) on biochemical recurrence (BCR) after robot-assisted laparoscopic prostatectomy (RALP). The aim was to report the incidence, extent, and location of PSMs over the inclusion period as well as the rates of BCR and cancer-related mortality, and determine if BCR is associated with PSM extent and/or location.MethodsRetrospective review of 530 consecutive patients who underwent RALP between 2003 and 2012. Kaplan-Meier (KM) survival analyses and Cox regressions were performed to determine variables associated with BCR.ResultsFor the 530 operated patients, evaluated at a median of 92 months (IQR, 87–99), PSMs were observed in 156 (29%), of which 24% were focal. Out of 172 PSMs, 126 (73%) were focal and 46 (27%) were extensive. The KM survival using BCR as endpoint was 0.81 (CI, 0.78–0.85) at 5 years and was 0.67 (CI, 0.61–0.72) at 10 years; and using cancer-related mortality as endpoint was 0.99 (CI, 0.99–1.00) at 5 years and 0.95 (CI, 0.92–0.98) at 10 years. Multi-variable analysis revealed the strongest predictors of BCR to be Gleason score ≥ 8 (HR = 7.97; CI, 4.38–14.51) and 4 + 3 (HR = 3.88; CI, 2.12–7.07), lymph nodes invasion (HR = 3.42; CI, 1.70–6.91), pT stage 3b or 4 (HR = 3.07; CI, 1.93–4.90), and extensive apical PSMs (HR = 2.62; CI, 1.40–4.90) but not focal apical PSMs (HR = 0.86; CI, 0.49–1.50; p = 0.586).ConclusionExtensive apical PSMs significantly increased the risk of BCR, independently from pT stage, Gleason score and lymph nodes invasion, while focal apical PSMs had no significant effect on BCR.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-5229-1) contains supplementary material, which is available to authorized users.

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“…Some had a low sample size and/or a short follow-up period [7,21,[25][26][27]. Maxeiner et al [28] also showed GS 8-10 increased risk of BCR in univariable analysis; however, they failed to perform a multivariable analysis due to insufficient sample size. Pettenati et al [29] used a logistic regression model for analysis and did not report multivariable Cox proportional hazards modelling.…”

Section: Discussionmentioning

confidence: 99%

Primary Gleason grade and Gleason grade group at positive surgical margins: a systematic review and meta‐analysis

John

Catterwell

et al. 2021

BJU International

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To systematically review and perform a meta-analysis of studies investigating the role of primary Gleason grade (PGG), Gleason score (GS) or Gleason grade group (GGG) at positive surgical margins (PSMs) after radical prostatectomy (RP) in predicting biochemical recurrence (BCR) and oncological outcomes. MethodsA systematic search was conducted using the MEDLINE, Scopus, Embase and Cochrane databases according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Studies published between 2005 and 2019 were included. The quality of the studies selected was assessed, and a protocol was registered and published in advance (PROSPERO: CRD42019131800). The primary outcome measure was BCR. Secondary outcome measures included cancerspecific survival, metastasis-free survival and overall mortality during the follow-up period. ResultsOur systematic search yielded 3116 unique results. Ten studies were selected for meta-analysis. The sample sizes of PSM cohorts varied from 200 to 956, while the median follow-up ranged from 1.5 to 13 years. Most studies used BCR as a surrogate marker for disease progression; only two studies reported other oncological outcomes. Meta-analysis was performed in selected groups (PGG, GS and GGG).

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Significant reduction in positive surgical margin rate after laparoscopic radical prostatectomy by application of the modified surgical margin recommendations of the 2009 International Society of Urological Pathology consensus

Cited by 11 publications

References 35 publications

Extent of positive surgical margins following radical prostatectomy: impact on biochemical recurrence with long-term follow-up

Extent of positive surgical margins following radical prostatectomy: impact on biochemical recurrence with long-term follow-up

Risk of biochemical recurrence based on extent and location of positive surgical margins after robot-assisted laparoscopic radical prostatectomy

Primary Gleason grade and Gleason grade group at positive surgical margins: a systematic review and meta‐analysis

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