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Surgical margin status of open versus laparoscopic radical prostatectomy specimens.
Terakawa T, Miyake H, Tanaka K, Takenaka A, Inoue TA, Fujisawa M.
Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.
Objectives: To compare the surgical margin (SM) status between open and laparoscopic radical prostatectomy (RRP and LRP, respectively) specimens. Methods: Surgical specimens from 137 patients undergoing LRP and 220 patients undergoing RRP for clinically localized prostate cancer were included in the analysis. SM status in each resected specimen, including the number of positive SM as well as their location, was examined. Results: The incidence of positive SM in the LRP group was significantly greater than that in the RRP group. Despite the lack of significant difference in the proportion of solitary positive SM between these two groups, the proportion of multiple positive SM in the LRP group was significantly greater than that in the RRP group. There was no significant difference in the incidence of anterior positive SM between the two groups, while the incidences of positive SM at the apex, posterior site and bladder neck in the LRP group were significantly greater than those in the RRP group. Furthermore, there were no significant preoperative parameters predicting positive SM in the LRP group. On the other hand, the biopsy Gleason score and clinical T stage were identified as significant predictors of positive SM in the RRP group, of which the biopsy Gleason score was independently related to the presence of positive SM. Conclusions: Clinical T stage and Gleason score could be useful predictors of SM status following RRP, while positive SM in LRP specimens were detected irrespective of preoperative parameters, suggesting the need for an effort for further refining the LRP procedure.
With no info to the contrary I would tend to assume that the laparoscopic group was with conventional laparoscopic surgery, not robotic. In which case one could expect surgical outcomes not as good as the open procedure. Because the surgeon is constrained by the method. In which case the study is indicative of the specific nature of the lesser outcomes that can be statistically expected. Thats what I see.
Very interesting report. It would be also interesting to know if the robotic procedure is included since I did have a positive margin at the bladder neck. The Dr. Walsh book did say that there was an advantage to regular open surgery because they can feel the cancer, so the info is out there during the decision making process.
Lee, I would but wonder just how many persons opt for the robotic RP based on an informed decision? Presently HIFU is all the rage in Europe, and robotic RP in the United States. Yet long term data relating to efficacy is minimal at present. Informed choice should be about weighing up the pro's and con's in light of your personal circumstance.
I for one was not given all of the information I needed. The only choices I was given were radiation and robotic. Had I known all I know now (about the robot shortcomings), I would have chosen open surgery.
We did choose Robotic from an informed decision. I was diagnosed in October of 2007 and did not have surgery until January 2008. That time was spent researching every option and meeting with doctors in each field. We chose Robotic mostly for the minimal evasive reasons because of never having had any type of surgery before and wanting to get back to our active lifestyle sooner. It is impossible to know what the outcome for each would be, and we don't like to look back and say "What If", BUT, if I would have known that the recovery would have gone as smooth as it did having had the robotic surgery, and if open surgery would be even twice as difficult, and IF I would have known that I would have a positive margin after robotic, if I had it to do over, I may choose open surgery to reduce that risk. So far, even with the positive margin, the psa has been <0.1. I'll be having the ultra sensitive test reading in July.
