Apical margins after robot-assisted radical prostatectomy: does technique matter?

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• The prostate apex is a common site for positive surgical margins after radical prostatectomy.
• Robot-assisted radical prostatectomy (RARP) is a widely used surgical technique.

Purpose of the Study:

• To evaluate the impact of two distinct dorsal venous complex (DVC) control techniques on apical margin positivity rates during RARP.
• To determine if the timing of DVC management influences surgical margin status at the prostate apex.

Main Methods:

• A retrospective review of 480 patients undergoing RARP between 2005 and 2008.
• Patients were divided into two groups: Group 1 (cold DVC incision before apical dissection) and Group 2 (suture ligation of DVC before apical dissection).
• Apical positive margin rates were compared between the two groups.

Main Results:

• 63% of patients had prostate cancer involving the apex.
• The overall apical positive margin rate was 5%.
• Group 1 (cold incision) had a significantly lower apical positive margin rate (2%) compared to Group 2 (suture ligation) (8%) (P=0.02).
• Mean operative blood loss was lower in Group 1 (331 mL) versus Group 2 (268 mL) (P=0.044).

Conclusions:

• Performing a cold incision of the DVC prior to apical dissection is associated with reduced rates of positive apical margins in RARP.
• This technique may offer an advantage in achieving negative surgical margins at the prostate apex.