The effect of wide resection during radical prostatectomy on surgical margins.

The impact of nerve-sparing on positive surgical margins during radical prostatectomy (RP) remains unclear. The objective of this study was to determine the incidence of positive surgical margins with a wide resection compared to a nerve-sparing technique.

A consecutive, single-surgeon patient cohort treated between August 2010 and November 2014 was reviewed. A standardized surgical approach of lobe-specific nerve-spare or wide resection was performed. Lobe-specific margin status and tumour stage were obtained from pathology reports. Univariable and multivariable associations between nerve management technique and lobe-specific positive surgical margin were determined.

Of 388 prostate lobes, wide resection was performed in 105 (27%) and nerve-sparing in 283 (73%). In 273 lobes without extra-prostatic extension (EPE), 0 of 52 (0%) had a positive margin when wide resection was performed compared to 20 of 221 (9%) if nerve-sparing was performed (p=0.02). In 115 lobes with EPE, 11 of 53 (21%) had a positive margin if wide resection was performed compared to 28 of 62 (45%) if nerve-sparing was performed (p=0.006). In multivariable analysis, the risk of a positive margin was decreased among patients who received wide resection as compared to nerve-spare (RR 0.43, 95% CI 0.26-0.71; p=0.001).

Surgical techniques to reduce positive surgical margins have become increasingly important as more patients with high-risk cancer are selecting surgery. The risk of a positive margin was greatly reduced using a standardized wide resection technique compared to nerve-sparing.

Canadian Urological Association journal = Journal de l'Association des urologues du Canada. 0000 [Epub]

Luke T Lavallée, Andrew Stokl, Sonya Cnossen, Ranjeeta Mallick, Chris Morash, Ilias Cagiannos, Rodney H Breau

Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada;; University of Ottawa, ON, Canada;; Ottawa Hospital Research Institute, Ottawa, ON, Canada., Ottawa Hospital Research Institute, Ottawa, ON, Canada., Ottawa Hospital Research Institute, Ottawa, ON, Canada., Ottawa Hospital Research Institute, Ottawa, ON, Canada., Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada;; University of Ottawa, ON, Canada;, Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada;; University of Ottawa, ON, Canada;, Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada;; University of Ottawa, ON, Canada;; Ottawa Hospital Research Institute, Ottawa, ON, Canada.

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