Impact of margin size on the incidence of local residual tumor after laparoscopic radical prostatectomy

被引:14
作者
Fromont, G
Cathelineau, X
Rozet, F
Prapotnich, D
Validire, P
Vallancien, G
机构
[1] Univ Paris 05, Inst Montsouris, Dept Pathol, Paris, France
[2] Univ Paris 05, Inst Montsouris, Dept Urol, Paris, France
关键词
prostate; prostatic neoplasms; prostatectomy; laparoscopy; neoplasm; residual;
D O I
10.1097/01.ju.0000140266.51848.92
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Purpose: Since October 2001 we have performed intraoperative frozen section (IFS) on the posterolateral areas of the radical prostatectomy specimen with bilateral nerve sparing. In cases of positive surgical margin (SMs) the corresponding neurovascular bundle (NVB) was resected. We evaluated the impact of several biological and pathological parameters on the incidence of local residual tumor in the NVB. Materials and Methods: A total of 487 laparoscopic radical prostatectomies with bilateral nerve sparing and IFS were performed between October 2001 and December 2003. When IFS was positive, the whole NVB was removed and analyzed after fixation in serial sections. The size of the positive SM was measured in its largest dimension. The association of NVB residual tumor with positive SM size, preoperative prostate specific antigen, pathological stage and Gleason score was analyzed using the t and chi-square tests, and logistic regression. Results: Of the 487 patients 84 had a positive SM on IFS. In 25 of the 84 additionally resected NVBs we found residual tumor. On univariate and multivariate analysis the only predictor of residual tumor was positive SM size (p <0.001). In all cases of a positive SM of 0.1 cm or less we found no residual tumor cells in the NVB. Conclusions: In case of a positive SM in the posterolateral area of the prostatectomy specimen margin size is predictive of the incidence of residual tumor in the corresponding NVB. This finding could help management and the decision about local adjuvant treatment.
引用
收藏
页码:1845 / 1847
页数:3
相关论文
共 18 条
[1]  
Babaian RJ, 2001, CANCER, V91, P1414
[2]   Anatomic site-specific positive margins in organ-confined prostate cancer and its impact on outcome after radical prostatectomy [J].
Blute, ML ;
Bostwick, DG ;
Bergstralh, EJ ;
Slezak, JM ;
Martin, SK ;
Amling, CL ;
Zincke, H .
UROLOGY, 1997, 50 (05) :733-739
[3]   EVALUATION OF RADICAL PROSTATECTOMY CAPSULAR MARGINS OF RESECTION - THE SIGNIFICANCE OF MARGINS DESIGNATED AS NEGATIVE, CLOSELY APPROACHING, AND POSITIVE [J].
EPSTEIN, JI .
AMERICAN JOURNAL OF SURGICAL PATHOLOGY, 1990, 14 (07) :626-632
[4]  
EPSTEIN JI, 1993, CANCER-AM CANCER SOC, V71, P3582, DOI 10.1002/1097-0142(19930601)71:11<3582::AID-CNCR2820711120>3.0.CO
[5]  
2-Y
[6]   Prognostic implications of a positive apical margin in radical prostatectomy specimens [J].
Fesseha, T ;
Sakr, W ;
Grignon, D ;
Banerjee, M ;
Wood, DP ;
Pontes, JE .
JOURNAL OF UROLOGY, 1997, 158 (06) :2176-2179
[7]   Intraoperative frozen section analysis during nerve sparing laparoscopic radical prostatectomy: Feasibility study [J].
Fromont, G ;
Baumert, H ;
Cathelineau, X ;
Rozet, F ;
Validire, P ;
Vallancien, G .
JOURNAL OF UROLOGY, 2003, 170 (05) :1843-1846
[8]   Impact of positive surgical margins on prostate cancer recurrence and the use of secondary cancer treatment: Data from the CaPSURE database [J].
Grossfeld, GD ;
Chang, JJ ;
Broering, JM ;
Miller, DP ;
Yu, J ;
Flanders, SC ;
Henning, JM ;
Stier, DM ;
Carroll, PR .
JOURNAL OF UROLOGY, 2000, 163 (04) :1171-1177
[9]   Laparoscopic radical prostatectomy: Oncological evaluation after 1,000 cases at Montsouris Institute [J].
Guillonneau, B ;
El-Fettouh, H ;
Baumert, H ;
Cathelineau, X ;
Doublet, JD ;
Fromont, G ;
Vallancien, G .
JOURNAL OF UROLOGY, 2003, 169 (04) :1261-1266
[10]   Cancer control with radical prostatectomy alone in 1,000 consecutive patients [J].
Hull, GW ;
Rabbani, F ;
Abbas, F ;
Wheeler, TM ;
Kattan, MW ;
Scardino, PT .
JOURNAL OF UROLOGY, 2002, 167 (02) :528-534