Positive surgical margins in robot-assisted or open radical prostatectomy: A comparative study / 第二军医大学学报

ABSTRACT

Objective To compare the positive surgical margins of the cases by a single surgeon using open versus robot-assisted radical prostatectomy. Methods We chose one surgeon’s 387 eligible cases with prostatic cancer, of whom 81 underwent open radical prostatectomy and 306 underwent robot-assisted radical prostatectomy in Department of Urology of Changhai Hospital of Second Military Medical University from Jan. 2009 to May 2017. A positive surgical margin was defined as the presence of tumor cells at the inked surface of the resected specimen. We collected all patients’ data from the prostate cancer follow-up database, including age, pre-operative level of prostate specific antigen (PSA), post-operative pathological Gleason score, pathological T staging, and upper and lower margins status. We used propensity score matching to match the data of two groups to ensure the consistency and finally analyzed the difference of positive surgical margins between the two matched groups. Multivariate logistic regression analysis was used to identify the independent influencing factors of positive surgical margins. Results We successfully matched 81 pairs of cases by propensity score matching using age, pre-operative level of PSA, post-operative pathologic Gleason score and pathological T staging as prediction variables. The positive rates of upper, lower and total surgical margins showed no significant differences between open and robot-assisted radical prostatectomy (upper:22.2%[18/81] vs 18.5%[15/81]; lower:29.6%[24/81] vs 30.9%[25/81]; total:38.3%[31/81] vs 38.3%[31/81]). Multivariate logistic regression analysis showed that pre-operative level of PSA (P=0.011) and pathological T stage (P=0.000) were independent influencing factors of positive surgical margin. Conclusion Robot-assisted and open radical prostatectomies show a similar integrity in radical prostatectomy.