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Intraoperative T staging in radical retropubic prostatectomy: is it reliable?
1Department of Urology, University of Miami School of Medicine, Miami, Florida, USA.
Urology
|May 19, 2001
Summary
Intraoperative assessment of surgical margins during radical prostatectomy is unreliable for predicting positive margins. Preoperative factors are better for deciding on nerve-sparing procedures to avoid positive surgical margins.
Area of Science:
- Urology
- Surgical Oncology
Background:
- Radical prostatectomy involves assessing surgical margins to prevent positive margins.
- Nerve-sparing prostatectomy aims to preserve erectile function but risks positive margins if tumor is extensive.
Purpose of the Study:
- To evaluate the accuracy of intraoperative T staging via palpation in predicting positive surgical margins.
- To determine if intraoperative assessment can guide decisions on performing nerve-sparing prostatectomy.
Main Methods:
- 100 consecutive radical prostatectomies were performed by a single surgeon.
- Intraoperative tactile assessment of tumor location and margin status was compared to final pathology.
- Pathologic findings were interpreted by a single pathologist.
Main Results:
- 39% of cases had positive surgical margins.
- Intraoperative margin assessment showed low sensitivity (7%) but high specificity (96%).
- Overall accuracy was 62%, with a negative predictive value of 62%.
Conclusions:
- Intraoperative assessment of margin status is not sufficiently accurate to guide neurovascular bundle excision.
- Preoperative prognostic factors and assessment of capsule integrity are recommended for deciding on nerve preservation.
