title: Risk Factors for Intraprostatic Incision into Malignant Glands at Radical Prostatectomy.
abstract: BACKGROUND
  Histologically identified intraprostatic incision (IPI) into malignant glands is associated with an increase in biochemical recurrence following radical prostatectomy (RP). However, the predictor of IPI is poorly evaluated.
  
  
  OBJECTIVE
  To evaluate the risk factors for IPI into cancer during RP for clinically localized prostate cancer (PCa).
  
  
  METHODS
  Between January 1993 and July 2013, 19 986 men with clinically localized PCa underwent RP at our institution. This study includes 14 434 cases that had complete clinicopathologic data. IPI was defined as an iatrogenic incision into the prostate resulting in the presence of malignant glands at the inked surgical margin, regardless of accompanying pathologic features.
  
  
  METHODS
  Open, retropubic, robot-assisted laparoscopic and pure laparoscopic RP.
  
  
  METHODS
  Univariate and multivariable logistic regression analyses were conducted for risk factors of IPI in RP specimens.
  
  
  CONCLUSIONS
  The overall incidence of IPI into malignant tissue was noted in 410 (2.8%) cases. In multivariable analysis, obesity, lower prostate weight, surgeon experience, and pure laparoscopic RP were associated with a higher risk of IPI. The odds ratios (OR) for body mass index and prostate weight were 1.05 (95% confidence interval [CI], 1.03-1.08; p<0.001) and 0.99 (95% CI, 0.98-0.99, p<0.001), respectively. The ORs for surgeon experience (>250 cases) and pure laparoscopic RP compared to open RP were 0.71 (95% CI, 0.55-0.90, p=0.005) and 2.05 (95% CI, 1.35-3.11; p=0.001), respectively.
  
  
  CONCLUSIONS
  The risk of IPI during RP is higher in men with obesity and lower prostate weight. In addition, a pure laparoscopic RP and the early series of each surgeon were associated with a higher risk of IPI. However, tumor characteristics were not associated with the IPI occurrence.
  
  
  RESULTS
  Intraprostatic incision occurrence is associated with obesity, small prostate, and surgeon experience and laparoscopic technique but not Gleason score and tumor stage.
authors.affiliation: The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Urology, Pusan National University Yangsan Hospital, Yangsan, South Korea. Electronic address: psw@pusan.ac.kr.
authors.forename: Sung-Woo
authors.initials: SW
authors.lastname: Park
authors.affiliation: The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Readal
authors.affiliation: The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Urology, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Byong Chang
authors.initials: BC
authors.lastname: Jeong
authors.affiliation: The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Humphreys
authors.affiliation: The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Epstein
authors.affiliation: The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Alan W
authors.initials: AW
authors.lastname: Partin
authors.affiliation: The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Misop
authors.initials: M
authors.lastname: Han
mesh_terms: D015142:Baltimore / Q000453:epidemiology; D002983:Clinical Competence; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D009765:Obesity / Q000150:complications; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome
keywords: Pathology; Prostate cancer; Prostatectomy
references.citation: Eur Urol. 2009 May;55(5):1037-63
references.pmid: 19185977
references.citation: Am J Surg Pathol. 2008 Aug;32(8):1201-6
references.pmid: 18580493
references.citation: Int Urol Nephrol. 2009;41(3):581-6
references.pmid: 18784981
references.citation: Urology. 2010 Nov;76(5):1097-101
references.pmid: 20303147
references.citation: J Urol. 2007 Oct;178(4 Pt 1):1306-10
references.pmid: 17698141
references.citation: Int J Surg Pathol. 2010 Jun;18(3 Suppl):118S-123S
references.pmid: 20484275
references.citation: BJU Int. 2011 Jun;107(12):1956-62
references.pmid: 21044243
references.citation: J Clin Oncol. 2000 Aug;18(15):2862-8
references.pmid: 10920134
references.citation: J Urol. 2010 Apr;183(4):1360-5
references.pmid: 20171687
references.citation: Prostate Cancer Prostatic Dis. 2010 Mar;13(1):28-33
references.pmid: 19488066
references.citation: J Urol. 1998 Aug;160(2):299-315
references.pmid: 9679867
references.citation: Eur Urol. 2014 Sep;66(3):450-6
references.pmid: 24290695
references.citation: Urol Clin North Am. 1996 Nov;23(4):651-63
references.pmid: 8948418
references.citation: Eur Urol. 2014 Feb;65(2):303-13
references.pmid: 23932439
references.citation: Urology. 2011 Mar;77(3):677-81
references.pmid: 21071070
references.citation: Eur Urol. 2014 Mar;65(3):521-31
references.pmid: 24287319
references.citation: Eur Urol. 2006 May;49(5):866-71; discussion 871-2
references.pmid: 16564614
references.citation: Eur Urol. 2011 Apr;59(4):613-8
references.pmid: 21195540
references.citation: BJU Int. 2010 Aug;106(3):378-84
references.pmid: 20067454
references.citation: BJU Int. 2012 Dec;110(11):1684-9
references.pmid: 22788795
references.citation: Scand J Urol Nephrol Suppl. 2005 May;(216):34-63
references.pmid: 16019758
references.citation: J Urol. 2011 Aug;186(2):511-6
references.pmid: 21680001
references.citation: Urology. 2001 Nov;58(5):746-51
references.pmid: 11711353
references.citation: BJU Int. 2011 Apr;107(8):1250-5
references.pmid: 20880194
references.citation: Eur Urol. 2010 Jun;57(6):1022-9
references.pmid: 20163911
references.citation: J Urol. 2003 Dec;170(6 Pt 1):2292-5
references.pmid: 14634399
references.citation: J Clin Oncol. 2004 Feb 1;22(3):446-53
references.pmid: 14691122
references.citation: J Urol. 2005 Nov;174(5):1798-801; discussion 1801
references.pmid: 16217290
references.citation: J Urol. 2007 Dec;178(6):2385-9; discussion 2389-90
references.pmid: 17936849
references.citation: J Urol. 2004 Jul;172(1):119-23
references.pmid: 15201750