Relationship between positive surgical margin after laparoscopic radical prostatectomy and intravesical prostatic protrusion length / 中华泌尿外科杂志

ABSTRACT

Objective:To identify the relationship between positive surgical margin after laparoscopic radical prostatectomy and intravesical prostatic protrusion length on preoperative magnetic resonance imaging.Methods:We retrospectively analyzed 110 patients with pathologic confirmed prostate carcinoma who underwent laparoscopic radical prostatectomy in our hospital. For all 110 patients, the average age was (70.4±7.8) years old, median pre-biopsy PSA was 12.23 ng/ml(range 0.78-110 ng/ml). There were 27 cases, 35 cases and 48 cases for biopsy Gleason score 6, 7 and ≥8. There were 73 patients with clinical stage T 1 and T 2, 37 patients with clinical stage T 3.The median prostatic volume was 38.16ml(range 11.83-163.36ml). MRI examination was performed in 1 week before the biopsy. Intravesical prostatic protrusion length (IPPL) was measured on MRI as the vertical distance from the tip of the protruding prostate to the base of the urinary bladder. All patients who underwent MRI preoperatively median IPPL was 3 mm(range 0-27 mm). There were 72 patients with IPPL<5 mm and 38 patients with IPPL≥5 mm respectively. All patients received extra-peritoneal laparoscopic radical prostatectomy. Parameters describing the surgical margin status and the location of positive surgical margin was recorded. The χ 2 tested the statistical significance in proportions differences. The multivariable logistic regression was used to assess risk factors for positive surgical margin and positive base surgical margin(PBSM). Results:Positive surgical margin rate was 38.1% for all patients, 25 patients(22.7%) had PBSM.χ 2 test showed that clinical stage ( P<0.001) and IPPL ( P=0.038) were related to the postoperative positive surgical margin. The clinical stage, Gleason score and IPPL were included in the multivariate logistic regression analysis. Multiple logistic regression showed that T 3 stage( P<0.001) was independent predictor for positive surgical margin. χ 2 test showed that clinical stage( P<0.001) and IPPL( P=0.001) were related to the postoperative PBSM. The clinical stage, Gleason score and IPPL were included in the multivariate logistic regression analysis. T 3 stage( P<0.001)and IPPL≥5 mm ( P=0.009) were independent predictors for PBSM according to multivariable logistic regression. Conclusions:For prostate cancer patients who received laparoscopic radical prostatectomy, clinical stage T 3was an independent risk factor for postoperative positive surgical margin. IPPL≥5 mm on preoperative magnetic resonance imaging and clinical stage T 3 were independent risk factors for PBSM.