title: [High-risk prostate cancer surgical margins during robot-assisted radical prostatectomy].
abstract: OBJECTIVE
  To evaluate the feasibility of robot-assisted radical prostatectomy (RARP) in high risk prostate cancer (HR). The rate of positive surgical margins (PSM) was compared between anticipated HR cancer according to D'Amico risk classification and discovered postoperative HR cancer.
  
  
  METHODS
  A retrospective study was conducted between 2006 and 2013 on patients who underwent RARP. Before surgery, patients were divided according to the D'Amico risk classification. After surgery, HR was defined as pT3a or pT3b, or Gleason score≥8 or positive lymph nodes. The rate of PSM was compared according to the D'Amico risk classification and postoperative HR.
  
  
  RESULTS
  During the study, 485 patients were reviewed. Before surgery, 10 % of cancers were classified as D'Amico 3 (49/485). After surgery, 27.6 % (134/485) were classified as HR. There was a significant difference between the rate of PSM in HR/D'Amico 3 and HR/non D'Amico 3 cancer, respectively 22.9 % and 34.3 % (P<0.001).
  
  
  CONCLUSIONS
  The RARP is feasible in HR with an average of 30 % of PSM as in open surgery. However, the accurate assessment of preoperative HR will allow a more adapted dissection and a decrease of rate of PSM. So it is necessary to improve the detection of HR and so to select the most suitable cancer for surgery.
  
  
  METHODS
  Level 5.
authors.affiliation: Service d'urologie, hôpital Le Bocage, CHU de Dijon, 14, rue Gaffarel, BP 77908, 21079 Dijon cedex, France. Electronic address: celine.duperron@chu-dijon.fr.
authors.forename: C
authors.initials: C
authors.lastname: Duperron
authors.affiliation: Service d'urologie, hôpital Le Bocage, CHU de Dijon, 14, rue Gaffarel, BP 77908, 21079 Dijon cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Moulin
authors.affiliation: Service d'urologie, hôpital Le Bocage, CHU de Dijon, 14, rue Gaffarel, BP 77908, 21079 Dijon cedex, France.
authors.forename: N
authors.initials: N
authors.lastname: Koutlidis
authors.affiliation: Service d'urologie, hôpital Le Bocage, CHU de Dijon, 14, rue Gaffarel, BP 77908, 21079 Dijon cedex, France.
authors.forename: E
authors.initials: E
authors.lastname: Mourey
authors.affiliation: Service d'urologie, hôpital Le Bocage, CHU de Dijon, 14, rue Gaffarel, BP 77908, 21079 Dijon cedex, France.
authors.forename: L
authors.initials: L
authors.lastname: Cormier
mesh_terms: D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D065287:Robotic Surgical Procedures
keywords: Cancer de prostate; Cancer à haut risque; High risk prostate cancer; Marge chirurgicale; Prostate cancer; Prostatectomie robot-assistée; Robot-assisted prostatectomy; Surgical margin