Robot Surgery May Improve Prostate Cancer Outcomes
Investigators studied 1,238 patients who underwent RALP by a single surgeon using a six-trocar transperitoneal approach. The patients had a median age of 61 years, mean PSA level of 5.3 ng/mL, and mean Gleason score of 6.6.
Overall, of the 1,238 surgical specimens, 146 had positive margins (11.8%). Positive margin status correlated with tumor stage. Stage 2, 3, and 4 tumors were associated with positive margin rates of 4%, 34%, and 40%. The distribution of positive margins was as follows: 15% bladder neck, 28% apex, 28% posterolateral, and 29% multifocal.
Positive margins correlated inversely with weighted prostate size. Prostates weighing less than 50 grams, 50-99 grams, and 100 grams or more had positive margin rates of 13.6%, 8.9%, and 5.5%, respectively.
David Arend, MD, a urology resident at
Though the researchers acknowledge long-term PSA recurrence data are necessary to determine the true oncologic efficacy of robotic prostatectomy, they conclude that “compared to contemporary open and laparoscopic series, the overall positive margin rate is low.”
The authors speculate that the potential reasons for these histopathologic outcomes are improved visualization due to less blood in the field and better optics and wristed instrumentation that improve precision.