達文西攝護腺切除手術術後病理切口邊緣陽性的預測指標

楊景偉¹，鍾孝仁²

振興醫療財團法人振興醫院¹，臺北榮民總醫院²，國立陽明大學書田泌尿科學研究中心³

The prediction of a positive surgical margin after

robotic-assisted radical prostatectomy

Ching-Wei Yang¹, Hsiao-Jen Chung^2,3

Department of Urology¹, Cheng-Hsin General Hospital

Department of Urology², Taipei Veteran General Hospital

Department of Urology³, School of Medicine and Shu-Tien Urological Science Center, National Yang-Ming University, Taipei, Taiwan

Purpose: Positive surgical margin (PSM) is a strong correlation with biochemical recurrence rate after racial prostatectomy (RP). To review and discuss the predictive factors in the PSM of the patients who underwent robotic-assisted radical prostatectomy (RARP) in a single medical center of Taiwan.

Material and Method: We evaluate historic cohort RARP patients treated by a single surgeon in Taipei Veterans General Hospital from 2010 to 2018. We examine correlated clinical data including age, body mass index, prostate-specific antigen, Gleason score in biopsy specimens, prostate weight, pathological T2/T3 stage, previous surgery history, prominent prostate median lobe, operative timing, estimated blood loss and experience of surgical cases with relation to PSM identified by the pathologists. We also compare the association between the laterality of nerve-sparing approach (NS) and the location of PSM.

Result: PSM rate increases with directly proportional to the estimated blood loss during RARP. There is no significant difference between PSM and parameters characterized by age, BMI, prostate weight and operative time. The rate of PSM keeps steady around 30% over the 400 cases. Factors of complex surgeries, for example, the presence of previous abdominal surgery, transurethral prostatic surgery and the prominent median lobe of the prostate have an average one-third of PSM rate. Three hundred and ten patients (73.8%) received bilateral NS, and 84 patients (20%) performed unilaterally. PSM rate was similar with about 29% and 29.8% in bilateral and unilateral NS, respectively (p=.366 and p=.915). PSM rate does not rise in selecting NS method after surgery even though patients classified by pT2 and T3 stage in final pathological reports. Patients who underwent NS laterally (right side, left side or both) during RARP has no correlation in growing PSM discovered by the location in RP specimens.

Conclusion: Preoperative PSA level and GS in the biopsy are two main predictors on PSM after RARP. Intraoperative bleeding will also affect pathological margin status. Whether selecting NS procedures or not does not increase the postoperative PSM rate in RP specimens.