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KMID : 0358320090500100955
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Korean Journal of Urology
2009 Volume.50 No. 10 p.955 ~ p.962
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Oncologic Outcome following Laparoscopic Radical Prostatectomy and the Difference in Oncologic Outcomes according to the Site of the Positive Margin: Comparison of the Apical Positive Margin with the Non-Apical Positive Margin
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Ha U-Syn
Kim Sung-In
Kim Su-Jin
Cho Hyuk-Jin
Hong Sung-Hoo
Lee Ji-Youl
Kim Joon-Chul
Kim Sae-Woong
Hwang Tae-Kon
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Abstract
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Purpose: The aim of this study was to analyze oncologic outcomes based on 7 years of consecutive experience with laparoscopic radical prostatectomy (LRP) and to assess the prognostic difference between an apical positive margin and a non-apical positive margin.
Materials and Methods: We reviewed 202 patients who underwent LRP between July 2001 and July 2007 (pathologic stage: T2-T3b, without any adjunctive therapy). Biochemical recurrence (bR) was defined as two consecutive prostate-specific antigen (PSA) values greater than 0.2 ng/ml. We analyzed the differences in bR among the negative margin group (N), the apical positive margin group (A), and the non-apical positive margin group (NA) and factors predicting bR.
Results: Overall 3-year probability of bR-free survival (bRFS) was 78% (pT2, 83.7%; pT3, 60.9%). For low-, intermediate-, and high-risk cancer, 3-year bRFS was 94.7%, 82.8%, and 60.7%, respectively. Of the 155 men who had negative and single-site positive margins, the numbers in the N, A, and NA groups were 108, 19, and 28, respectively. bR rates for the N, A, and NA groups were 14.8%, 36.8%, and 46.4%, respectively. Kaplan-Meier curves showed that a positive surgical margin had a significant higher bR compared with the N group; however, the A group experienced a similar bRFS compared with the NA group (p=0.613). Multivariate Cox proportional hazards analysis indicated no significant difference of effect on time to bR between the A and NA groups (hazard ratio=1.213; 95% confidence interval: 0.482-3.052).
Conclusions: Our results were almost identical to previous reports of radical prostatectomy in pT2 disease. With increasing experience, we could expect improved oncologic outcomes. In comparison with the NA group, the A group did not show a significant prognostic difference.
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KEYWORD
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Prostatectomy, Recurrence, Laparoscopy
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