title: Significant reduction in positive surgical margin rate after laparoscopic radical prostatectomy by application of the modified surgical margin recommendations of the 2009 International Society of Urological Pathology consensus.
abstract: OBJECTIVE
  To verify retrospectively the margin status and analyse the location and characteristics of positive surgical margins (PSMs) in patients undergoing radical prostatectomy (RP), by a central pathology review, based on the consensus conference 2009 updated margin criteria from the International Society of Urological Pathology (ISUP).
  
  
  METHODS
  The detailed PSM characteristics of 441 patients who underwent laparoscopic RP (LRP) between 1999 and 2007 were centrally reviewed with regard to location, number, Gleason score at the PSM and tumour width. Predictors of PSMs and the impact of several PSM characteristics on clinical outcomes were examined. Patient characteristics were compared using the chi-squared test. Differences in recurrence-free survival (RFS) rates were analysed using the log-rank test and presented as Kaplan-Meier survival curves. Univariable and multivariable Cox regression analysis for the prediction of RFS was performed.
  
  
  RESULTS
  Central pathology review using the updated PSM definition according to ISUP 2009, resulted in reclassification of a substantial number of patients with PSMs (n = 113, 26.6%) as R0. Several PSM characteristics with a higher risk of biochemical recurrence (BCR) were identified as the strongest independent predictors of RFS: pathological stage; Gleason score; and the presence of multiple PSMs (hazard ratio [HR] 1.78; 95% confidence interval [CI] 1.08-2.96; P = 0.025). Further analysis replacing the location of PSM by the width categories of PSM showed that a PSM >3 mm was an independent predictor of RFS (HR 1.72; 95% CI 1.08-2.72; P = 0.022).
  
  
  CONCLUSIONS
  The impact of PSMs after LRP for prostate cancer remains unclear. PSMs in the present cohort of patients undergoing LRP had different characteristics and conferred different risks of BCR. A better understanding of PSM characteristics and a careful standardized pathological evaluation is needed to adequately counsel patients with respect to prognosis and adjuvant therapy after LRP.
authors.affiliation: Department of Urology, Charité - Universitaetsmedizin Berlin, Berlin, Germany. andreas.maxeiner@charite.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Maxeiner
authors.affiliation: Department of Urology, Charité - Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Magheli
authors.affiliation: Department of Pathology, Charité - Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Korinna
authors.initials: K
authors.lastname: Jöhrens
authors.affiliation: Department of Pathology, Charité - Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Ergin
authors.initials: E
authors.lastname: Kilic
authors.affiliation: Department of Urology, Charité - Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Tom Lukas
authors.initials: TL
authors.lastname: Braun
authors.affiliation: Department of Urology, Charité - Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Kempkensteffen
authors.affiliation: Department of Urology, Charité - Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Hinz
authors.affiliation: Department of Urology, Charité - Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Stephan
authors.affiliation: Department of Urology, Charité - Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Kurt
authors.initials: K
authors.lastname: Miller
authors.affiliation: Department of Urology, Charité - Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Jonas
authors.initials: J
authors.lastname: Busch
mesh_terms: D000328:Adult; D000368:Aged; D003245:Consensus Statements as Topic; D019983:Guideline Adherence; D006801:Humans; D010535:Laparoscopy; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies
keywords: laparoscopy; positive surgical margin; prostate cancer; radical prostatectomy; survival