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Margin Status Predicts Biochemical Recurrence
Thomas Nevers, BA1, Serge Ginzburg, MD2, Ilene Staff, PhD1, Jamie Fisch, BA1, Alison Champagne, BA1, Joseph Tortola, BS1, Stuart S. Kesler, MD1, Joseph R. Wagner, MD1.
1Hartford Hospital, Hartford, CT, USA, 2University of Connecticut, Farmington, CT, USA.

BACKGROUND: To examine the impact of surgical margin status as well as positive margin length and multiplicity on biochemical recurrence in a large cohort of robotic-assisted laparoscopic prostatectomy (RALP) patients
METHODS: A retrospective review of a prospectively maintained, IRB approved radical prostatectomy database was conducted. Demographic, clinical and pathologic characteristics were prospectively recorded. Margin status, margin multiplicity and when available margin length was extracted from the pathology report. Multiple pathologists in a single institution performed the initial interpretation using a modified Stanford protocol. Margin length was dichotomized as focal (≤3mm) or extensive (>3mm). Biochemical recurrence (BCR) was defined as post-operative PSA ≥0.2 ng/mL. Patients who received adjuvant radiation or androgen depravation therapy (42) were excluded from the recurrence analysis. Univariate and multivariate statistical analyses were performed using SPSS v.16.
RESULTS: 1657 patients underwent RALP at our institution between December 2003 and April 2009 by three surgeons, of which 1479 had sufficient data for BCR analysis. Overall positive margin rate was 26%, with 2.7 times higher incidence of pT3 disease in the positive margin group (40% vs. 15%). Multivariate analysis confirmed statistically significant influence of margin positivity, margin multiplicity and margin extent.
CONCLUSIONS: Completeness of surgical resection has significant influence on biochemical recurrence after RALP. Margin positivity, multiplicity and extent may play a role in the decision making process for adjuvant therapy. Surgeons should strive to lower positive margin rates.


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