Related Experiment Video
Updated: May 26, 2025
Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
Impact of positive surgical margin location after radical prostatectomy: a network meta-analysis
Athul John1,2, Thomas Milton3, Aashray Gupta3
1Adelaide Medical School, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia. athul.john@adelaide.edu.au.
Objective:
To perform a network meta-analysis comparing the impact of different positive surgical margin locations (Comparisons and intervention) on biochemical recurrence (Outcome) in patients undergoing radical prostatectomy (Population).
Methods:
According to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, a protocol was registered (PROSPERO: CRD42022119025) and a search across four databases was conducted (the MEDLINE, Scopus, Embase and Cochrane). The primary outcome was biochemical recurrence (BCR). A network meta-analysis was conducted. Further subgroup analysis was performed to evaluate studies exploring robot-assisted radical prostatectomy (RALP).
Results:
Our search yielded 1249 unique results; 22 studies were analysed. Anterior margins had the highest risk of BCR (HR 2.46, 95%CI 1.67-3.61, I2 = 76%) followed by posterior (HR 2.29, 95%CI 1.43-3.66, I2 = 0%), bladder base (HR 2.06, 95%CI 1.61-2.64, I2 = 69%), apical (HR 1.88, 95%CI 1.51-2.35, I2 = 59%), and posterolateral margins (HR 1.70, 95%CI 1.14-2.25, I2 = 60%). Given significant heterogeneity, subgroup analysis was performed. In the RALP subgroup, anterior margins also demonstrated the highest recurrence risk (HR 3.74, 95%CI 2.47-5.66, I2 = 0%), followed by apical (HR 2.43, 95%CI 1.97-8.00, I2 = 0%), posterior (HR 2.23, 95%CI 1.47-3.38), base (HR 1.65, 95%CI 1.29-2.11, I2 = 0%), and posterolateral margin (HR 1.54, 95%CI 1.07-2.22).
Conclusions:
The risk of BCR after radical prostatectomy varies by PSM location, with the highest recurrence risk observed at anterior margins.
