Robot-assisted radical prostatectomy: current evaluation of surgical margins in clinically low-, intermediate-, and high-risk prostate cancer.
OBJECTIVE
Concern exists over a lack of tactile sensation and positive surgical margins (PSMs) in patients undergoing robot-assisted radical prostatectomy. We report our PSM rates in our most current 500 cases and particularly in clinically high-risk disease.


METHODS
After implementation of our present technique at case #251, we report PSM rates according to pathologic stage and D'Amico's risk stratification: low risk (prostate-specific antigen [PSA] <10, Gleason score [GS] 5-6, cT1-T2A), intermediate risk (PSA 10-20, GS 7, cT2B), and high risk (PSA >20, GS 8-10, cT3). Patients with cT2b/T3 disease or GS 8 to 10 and multiple cores with >30% involvement underwent wide excision of the neurovascular bundle. PSM was defined as ink on tumor.


RESULTS
The overall PSM rate was 7.4%: pT2 = 3.1%, pT3 = 15.9%, and pT4 = 55.6%. PSMs occurred in 13 (4.9%) low, 10 (5.8%) intermediate, and 14 (22.6%) high D'Amico risk patients. Of the 62 high-risk patients, the median PSA was 6.9 (range 2.2-97.9); biopsy GS was 6 to 7 (26%) and 8 to 10 (74%). For preoperatively palpable disease, the PSM rate was 9.9%: cT1 = 6.0%, cT2 = 7.7%, and cT3 = 26.3%. No PSMs occurred along the neurovascular bundle.


CONCLUSIONS
Since 2005, 500 men with clinically low-, intermediate-, and high-risk prostate cancer have undergone robot-assisted radical prostatectomy with acceptable surgical margin rates. In patients with high-risk and usually palpable disease, PSM rates were also acceptable despite the lack of tactile sensation with the robot.
Yee
David S
DS
Department of Urology, University of California, Irvine Medical Center, Orange, California, USA. davidyee74@msn.com
Narula
Navneet
N
Amin
Mahul B
MB
Skarecky
Douglas W
DW
Ahlering
Thomas E
TE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011467:Prostate / Q000473:pathology / Q000601:surgery; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors; D012371:Robotics / Q000379:methods*