title: Positive surgical margins and accessory pudendal artery preservation during laparoscopic radical prostatectomy.
abstract: OBJECTIVE
  To determine whether preservation of accessory pudendal arteries (APAs) adversely influences the rate of positive surgical margins (PSMs) during laparoscopic radical prostatectomy (LRP).
  
  
  METHODS
  Between January 2003 and January 2005, 377 men with clinically localized prostate cancer underwent a LRP; 325 met inclusion criteria for this study. The variety (apical or lateral), laterality (left or right), size, and preservation status of all identified APAs were prospectively recorded. A genitourinary pathologist mapped the specimens and established tumor locations and PSM sites.
  
  
  RESULTS
  Ninety-six of 325 men (30%) were found to have 125 separate APAs. The apical variety predominated; 56% of APAs were apical and 44% were lateral. Successful preservation was possible for 104/125 (83%) individual arteries. The overall rate of PSM was 11.7%. The rates for those with and without identified APAs were 9% and 13%, respectively (p=0.4). The incidence of PSMs in the ipsilateral region of APA localization was not affected by preservation status; ipsilateral PSM rates were 3% and 6% for those preserved and not preserved, respectively (p=0.5).
  
  
  CONCLUSIONS
  Identification and preservation of APAs during laparoscopic radical prostatectomy did not adversely affect the rates of PSMs. APA preservation can be undertaken without compromise to the oncological integrity of the laparoscopic radical prostatectomy.
authors.affiliation: Department of Urology, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
authors.forename: Fernando P
authors.initials: FP
authors.lastname: Secin
authors.forename: Nicholas
authors.initials: N
authors.lastname: Karanikolas
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kuroiwa
authors.forename: Andrew
authors.initials: A
authors.lastname: Vickers
authors.forename: Karim
authors.initials: K
authors.lastname: Touijer
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guillonneau
mesh_terms: D001158:Arteries / Q000033:anatomy & histology*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome