Positive Margins after Laparoscopic Radical Prostatectomy: A Prospective Study of 100 Cases Performed by 4 Different Surgeons

Objective: Laparoscopic radical prostatectomy (LRP) has been refined by experienced surgeons into a competitive treatment alternative for localized prostate cancer. Less is known, however, about the outcomes of “learning curve” cases from newly trained surgeons. We prospectively studied 100 cases of LRP performed by 2 senior and 2 junior surgeons and addressed the rates of positive margins—an important early endpoint of oncologic efficacy. Methods: 100 consecutive cases of LRP were performed by two senior ( n=62) and two junior surgeons ( n=38) by a 5-port transperitoneal route. Whole-mount step-section prostate specimens were examined by Stanford protocol. Results: Positive margins occured in 25% of cases: 18% for pT2a (2/11), 18% for pT2b (11/61), 45% for pT3a (10/22), and 50% for pT3b (2/4) ( p=0.002 pT2 vs. pT3). By surgeon experience, the rates were 19% (12/62) for senior and 34% (13/38) for junior ( p=0.04). However, in a multiple logistic regression analysis, only pathologic stage ( p=0.083) and Gleason sum ( p=0.0133) reached statistical significance, while surgeon experience did not ( p=0.0992). Conclusion: Positive margin rates after laparoscopic radical prostatectomy are significantly influenced by pathologic stage and Gleason score, and are within the range reported from open series. The higher positive margin rate from junior surgeons, although not statistically significant, suggests the need for further study and continued mentoring during surgery and/or video review of cases to improve oncologic results.