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The addition of robotic surgery to an established laparoscopic radical prostatectomy program: effect on positive surgical margins.
Can J Urol. 2008 Apr; 15(2):3994-9.CJ

Abstract

PURPOSE

The addition of robotic assistance with the da Vinci surgical system for performing laparoscopic radical prostatectomy has been reported to improve surgical outcomes. In order to evaluate the benefit of robotic assistance to improve cancer control in a center with an established laparoscopic radical prostatectomy program, we evaluated the incidence of positive surgical margins in both transperitoneal laparoscopic (LRP) and robotically assisted laparoscopic radical prostatectomy (RALP).

MATERIALS AND METHODS

We performed an Institutional Review Board (IRB) approved, retrospective review of 247 men with clinically localized prostate cancer treated with either a LRP or a RALP from March 2000 to August 2006. Pathology reports were reviewed for both preoperative and postoperative Gleason score as well as clinical and pathological stage. Surgical pathology specimens were evaluated using a whole mount, step section technique. Extracapsular extension, seminal vesicle invasion and positive margins were noted when present in the final surgical pathologic specimens.

RESULTS

One hundred ninety seven patients underwent LRP, and 50 patients underwent RALP. Seven of the 197 LRP required open conversion to retropubic radical prostatectomy, and were excluded. None of the RALP were converted. The overall positive surgical margin rate for LRP and RALP was 18% (35/190) and 6% (3/50), respectively (p = 0.032). When examining pathologically organ confined specimens (pT2), the positive surgical margin rate was 12% (20/161) and 4.7% (2/43) for the LRP and RALP cohorts, respectively (p = 0.181). For pathologic disease that has spread outside the capsule (pT3/T4), the positive surgical margin rate was 54% (15/28) and 14% (1/7) for LRP and RALP, respectively (p = 0.062). Patient age, race and prostate volume were not significant factors in the incidence of positive surgical margins.

CONCLUSION

The addition of robotic assistance to an established laparoscopic radical prostatectomy program appears to reduce the incidence of positive surgical margins. Data is maturing to determine whether this will lead to improved functional and oncologic outcomes.

Authors+Show Affiliations

Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18405448

Citation

Trabulsi, Edouard J., et al. "The Addition of Robotic Surgery to an Established Laparoscopic Radical Prostatectomy Program: Effect On Positive Surgical Margins." The Canadian Journal of Urology, vol. 15, no. 2, 2008, pp. 3994-9.
Trabulsi EJ, Linden RA, Gomella LG, et al. The addition of robotic surgery to an established laparoscopic radical prostatectomy program: effect on positive surgical margins. Can J Urol. 2008;15(2):3994-9.
Trabulsi, E. J., Linden, R. A., Gomella, L. G., McGinnis, D. E., Strup, S. E., & Lallas, C. D. (2008). The addition of robotic surgery to an established laparoscopic radical prostatectomy program: effect on positive surgical margins. The Canadian Journal of Urology, 15(2), 3994-9.
Trabulsi EJ, et al. The Addition of Robotic Surgery to an Established Laparoscopic Radical Prostatectomy Program: Effect On Positive Surgical Margins. Can J Urol. 2008;15(2):3994-9. PubMed PMID: 18405448.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The addition of robotic surgery to an established laparoscopic radical prostatectomy program: effect on positive surgical margins. AU - Trabulsi,Edouard J, AU - Linden,Robert A, AU - Gomella,Leonard G, AU - McGinnis,Davis E, AU - Strup,Stephen E, AU - Lallas,Costas D, PY - 2008/4/15/pubmed PY - 2008/8/30/medline PY - 2008/4/15/entrez SP - 3994 EP - 9 JF - The Canadian journal of urology JO - Can J Urol VL - 15 IS - 2 N2 - PURPOSE: The addition of robotic assistance with the da Vinci surgical system for performing laparoscopic radical prostatectomy has been reported to improve surgical outcomes. In order to evaluate the benefit of robotic assistance to improve cancer control in a center with an established laparoscopic radical prostatectomy program, we evaluated the incidence of positive surgical margins in both transperitoneal laparoscopic (LRP) and robotically assisted laparoscopic radical prostatectomy (RALP). MATERIALS AND METHODS: We performed an Institutional Review Board (IRB) approved, retrospective review of 247 men with clinically localized prostate cancer treated with either a LRP or a RALP from March 2000 to August 2006. Pathology reports were reviewed for both preoperative and postoperative Gleason score as well as clinical and pathological stage. Surgical pathology specimens were evaluated using a whole mount, step section technique. Extracapsular extension, seminal vesicle invasion and positive margins were noted when present in the final surgical pathologic specimens. RESULTS: One hundred ninety seven patients underwent LRP, and 50 patients underwent RALP. Seven of the 197 LRP required open conversion to retropubic radical prostatectomy, and were excluded. None of the RALP were converted. The overall positive surgical margin rate for LRP and RALP was 18% (35/190) and 6% (3/50), respectively (p = 0.032). When examining pathologically organ confined specimens (pT2), the positive surgical margin rate was 12% (20/161) and 4.7% (2/43) for the LRP and RALP cohorts, respectively (p = 0.181). For pathologic disease that has spread outside the capsule (pT3/T4), the positive surgical margin rate was 54% (15/28) and 14% (1/7) for LRP and RALP, respectively (p = 0.062). Patient age, race and prostate volume were not significant factors in the incidence of positive surgical margins. CONCLUSION: The addition of robotic assistance to an established laparoscopic radical prostatectomy program appears to reduce the incidence of positive surgical margins. Data is maturing to determine whether this will lead to improved functional and oncologic outcomes. SN - 1195-9479 UR - https://www.unboundmedicine.com/medline/citation/18405448/The_addition_of_robotic_surgery_to_an_established_laparoscopic_radical_prostatectomy_program:_effect_on_positive_surgical_margins_ L2 - http://www.canjurol.com/abstract.php?ArticleID=&version=1.0&PMID=18405448 DB - PRIME DP - Unbound Medicine ER -