Frequency of Positive Surgical Margin at Prostatectomy and Its Effect on Patient Outcome

Table 1

Comparison of PSM rates by technical approach.

First author, yr	No. of pts	Cohort years	Median f/u, yr	Open		Laparoscopic		Robotic		Failure rate if PSM
				PSM rate	𝑃 value	PSM rate	HR, 𝑃 val.	PSM rate	HR, 𝑃 val.
Williams; 2010 [7]	4240	2004–2006		20.1%		17.4%		17.4%
Coelho; 2010 [8]	≥250^††	1994–2009		24.0%		21.3%		13.6%
Sciarra; 2010 [9]	200	2003–2007		18% anterograde, 14% retrograde	𝑃=.03	—		—		—
Williams; 2010 [10]	950	2005–2008		7.6%		13.5%,	HR 1.9*, 𝑃=.007	—		—
Coelho; 2010 [11]	876	2008-2009		—		—		pT2, 6.8%, pT3, 34.0%	𝑃<.0001	—
Guru; 2009 [12]	480	2005–2008		—		—		5% apical, 2% versus 8%**		—
Bong; 2009 [13]	301	1994–2006	2.0	24.7% at 1 institution but 4.2% at another	𝑃<.01 ***	—		—		25.6% at 1 institution but 100% at other
Hakimi; 2009 [14]	150	2001–2008				13.7%		12%		6.7% versus 5.3%; 𝑃=.37
Laurila; 2009 [15]	192	2006		14%		—		13%	𝑃=.5, no diff in apical margin	—
Terakawa; 2008 [16]	137	2000–2007		PSM	Not signif.	—		More multiple PSM, get #		—
Smith; 2007 [17]	400	2002–2006		35%^†		—		15%	𝑃<.001	—
Silva; 2007 [18]	179	1999–2003		41.6%		—		24.44%	𝑃=.023	—
Touijer; 2007 [19]	1177	2003–2005		11.0%; pT2 5.3%,; pT3 22.0%		11.3%; pT2 8.2%; pT3 17.2%	HR 1.2, 𝑃=.5	—		—

*OR falls to 1.6 if nerve-sparing is eliminated as a variable (𝑃=.05).
**Lower rate achieved by cold incision of the dorsal venous complex before suture ligation.
***For the same surgeon; but higher average pathologic stage at the first institution.
^†But open method was used for more high-risk cases and also cases with a higher preoperative PSA, 𝑃=.002.
^††Review of several papers.