PD43: Prostate Cancer: Localized: Surgical Therapy II
PD43-02: The Impact of Case Order on Positive Surgical Margins for Prostate Cancer: A Multi-Institutional Analysis
Friday, May 15, 2020
7:00 AM – 9:00 AM
Laura Bukavina MD MPH, Kirtishri Mishra MD, Amr Mahran MD MS, Sarah Markt ScD MPH, Fredrick Schumacher PhD MPH, Britt Conroy MD PhD JD MS, Robert Abouassaly MD MS, Gregory MacLennan MD, Garrett Smith MD, Elizabeth Ferry MD, Daniel Wong MS, Yair Lotan MD, Claus Roehrborn MD, David Sharp MD, Chaparala Hemant MD, Nayan Shah BS, Kareem Alazem MD, Ali Moinzadeh MD, Brittany Adamic MD, Gregory Zagaya MD, Puneet Kang BS, Holly Lawry BS, Benjamin Lee MD, Adam Callaway MD MPH, Jason Jankowski MD, Lee Ponsky MD
MD MPH Case Western/University Hospitals Cleveland Medical Center
Introduction: Our aim was to evaluate whether sequential surgeries result in worse outcomes, such as positive surgical margins (PSM), in patients undergoing robotic-assisted laparoscopic prostatectomy (RALP), by comparing the second surgery to the first.
Methods: We retrospectively analyzed 898 RALP cases (449 sequential pairs) across eight institutions, from 1/1/2015-07/1/2018. Pooling the data across eight institutions, we calculated odds ratio (OR) and 95% confidence intervals (95% CI) using multivariable logistic regression models, adjusting for age, BMI, PSA, Grade, Tumor Involvement, EPE, and SVI, modeling PSM as the dependent variable, and case sequence as the independent variable of interest. Due to potential heterogeneity between institutions, we then conducted a meta-analysis to calculate a random-effects OR .
Results: A total of 898 RALP cases were included in this study, across 8 institutions. There were no differences between the first and the second cases of the day in PSA (6.2 ng/mL vs 6.3 ng/ml) total lymph node yield (12.0 vs. 11.0), seminal vesicle invasion (49% vs 52%), operative time (216.0 mins vs 220.0 mins), BMI (28.4 kg/m2 vs 28.6 kg/m2), prostate volume (45.1 g vs 45.2 g) and positive surgical margin rate (n=121 vs n=135). The second case of the day more likely to have higher prostatic involvement (p= 0.02), as well as higher blood loss (p= 0.25).
In multivariable models, there were no differences in positive surgical margin (PSM) between the first and the second cases of the day. However, SVI (OR 1.92), EPE (OR 2.05), tumor involvement (OR 1.03), PSA (OR 1.02) as well as individual institution were statistically significantly associated with an increased risk of positive surgical margin.
Conclusions: Data from our multi-institutional study suggests no statistically significant difference in lymph node yield, operative time, or PSM between the first and the second RALP of the day. Despite the lack of statistical significance by conventional parameters, there is a strong trend for increased rate of PSM in the second prostatectomy of the day in select patients. Disease specific factors such as EPE, SVI, PSA, tumor involvement as well as institutional experience are all associated with increased risk for positive surgical margin. Source of