Are you now a good surgeon? T2 positive margin status as a quality outcome measure following radical prostatectomy.
OBJECTIVE
To assess potential biases, such as the reporting pathologist, that may affect objectivity of T2 positive margin rates as a quality outcome measure following radical prostatectomy.


METHODS
Prospective data on 183 consecutive LRP patients with pT2 disease, operated on by a single surgeon (2003-2009), were studied. Outcomes were grouped as pre-, peri-, and post-operative and included: age, ethnicity, Gleason score, reporting pathologist, percentage of positive cores, operative time, blood loss, nerve-sparing status, hospital stay and prostate weight. Descriptive analysis and logistic regression analysis were carried out to compare these variables by positive margin status.


RESULTS
A total of 30 (16.4 %) positive surgical margins (PSMs) were reported. Surgical stage, earlier date of surgery, and lower prostatic weight showed statistically significant associations with PSM status in both univariate and multivariate analysis. The reporting pathologist was not found to be predictive of PSMs (P = 0.855).


CONCLUSIONS
We showed that the reporting pathologist does not influence T2 positive margin status, in contrast to tumour characteristics and surgeon experience. T2 positive margin assessment therefore appears to be an objective quality outcome measure.
Cancer Epidemiology Group, Division of Cancer Studies, Research Oncology, School of Medicine, Guy's Hospital, King's College London, 3rd Floor, Bermondsey Wing, London, SE1 9RT, UK. arees.damani@kcl.ac.uk.
Arees
A
Damani
Cancer Epidemiology Group, Division of Cancer Studies, Research Oncology, School of Medicine, Guy's Hospital, King's College London, 3rd Floor, Bermondsey Wing, London, SE1 9RT, UK.
Mieke
M
Van Hemelrijck
Cancer Epidemiology Group, Division of Cancer Studies, Research Oncology, School of Medicine, Guy's Hospital, King's College London, 3rd Floor, Bermondsey Wing, London, SE1 9RT, UK.
Wahyu
W
Wulaningsih
Cancer Epidemiology Group, Division of Cancer Studies, Research Oncology, School of Medicine, Guy's Hospital, King's College London, 3rd Floor, Bermondsey Wing, London, SE1 9RT, UK.
Danielle
D
Crawley
The Royal Marsden NHS Foundation Trust, London, UK.
Declan
D
Cahill
D016063:Blood Loss, Surgical; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D061646:Operative Time; D009929:Organ Size; D017063:Outcome Assessment, Health Care; D000072142:Pathologists; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology / Q000601:surgery; D011468:Prostatectomy / Q000592:standards*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D019984:Quality Indicators, Health Care; D066231:Surgeons
Laparoscopic surgery; Outcomes assessment; Positive margins; Prostate cancer; Radical prostatectomy