Impact of Centralisation of Radical Prostatectomy Driven by the Introduction of Robotic Systems on Positive Surgical Margin and Biochemical Recurrence in pT2 Prostate Cancer
ABSTRACT Background To assess how centralisation of cancer services via robotic surgery influenced positive surgical margin (PSM) occurrence and its associated risk of biochemical recurrence (BCR) in cases of pT2 prostate cancer (PC). Methods Retrospective analysis of all radical prostatectomy (RP)...
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Wiley
2025-01-01
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| Series: | Cancer Medicine |
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| Online Access: | https://doi.org/10.1002/cam4.70514 |
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| author | Ibrahim Ibrahim Omar Kouli Sanjana Ilangovan Melanie Sneddon Sarika Nalagatla Carol Marshall Lorenzo Dutto Hing Y. Leung Imran Ahmad |
| author_facet | Ibrahim Ibrahim Omar Kouli Sanjana Ilangovan Melanie Sneddon Sarika Nalagatla Carol Marshall Lorenzo Dutto Hing Y. Leung Imran Ahmad |
| author_sort | Ibrahim Ibrahim |
| collection | DOAJ |
| description | ABSTRACT Background To assess how centralisation of cancer services via robotic surgery influenced positive surgical margin (PSM) occurrence and its associated risk of biochemical recurrence (BCR) in cases of pT2 prostate cancer (PC). Methods Retrospective analysis of all radical prostatectomy (RP) cases performed in the West of Scotland during the period from January 2013 to June 2022. Primary outcomes were PSM and BCR. The secondary outcomes compared the impact of centralisation and surgical approach on PSM and BCR; and margin length and location on BCR. Propensity score matching and Cox regression models were performed using R. Results A total of, 907 patients were included; 662 robot assisted radical prostatectomy (RARP), 245 open RP. PSM rate was 17.7% (161/907), similar in RARP and open cohorts. Patients with PSM had higher rates of BCR; 26.7%, compared to 8.7% in patients with no PSM. Patients with margins of ≥ 1 mm had higher risk of developing BCR. Patients who underwent open RP had increased incidence of PSM ≥ 1 mm; 40/43 (93%) compared to 83/117 (71%) in robotic approach (p = 0.003). Limitations include the study being retrospective, introduction of centralisation and robot concurrently, and evolution of practice. Discussion PSMs in pT2 PC are associated with higher rates of BCR. Introduction of centralisation via the robot had no impact on PSM occurrence or BCR, although did demonstrate a reduction in PSM length. |
| format | Article |
| id | doaj-art-bb7fcef932714027a02cbc5a551c8ec7 |
| institution | Kabale University |
| issn | 2045-7634 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj-art-bb7fcef932714027a02cbc5a551c8ec72025-01-24T08:46:07ZengWileyCancer Medicine2045-76342025-01-01142n/an/a10.1002/cam4.70514Impact of Centralisation of Radical Prostatectomy Driven by the Introduction of Robotic Systems on Positive Surgical Margin and Biochemical Recurrence in pT2 Prostate CancerIbrahim Ibrahim0Omar Kouli1Sanjana Ilangovan2Melanie Sneddon3Sarika Nalagatla4Carol Marshall5Lorenzo Dutto6Hing Y. Leung7Imran Ahmad8Department of Urology Queen Elizabeth University Hospital Glasgow UKThe Walton Centre Aintree University Hospital Liverpool UKDepartment of Urology Queen Elizabeth University Hospital Glasgow UKDepartment of Urology Queen Elizabeth University Hospital Glasgow UKDepartment of Urology Queen Elizabeth University Hospital Glasgow UKDepartment of Urology Queen Elizabeth University Hospital Glasgow UKDepartment of Urology Queen Elizabeth University Hospital Glasgow UKDepartment of Urology Queen Elizabeth University Hospital Glasgow UKDepartment of Urology Queen Elizabeth University Hospital Glasgow UKABSTRACT Background To assess how centralisation of cancer services via robotic surgery influenced positive surgical margin (PSM) occurrence and its associated risk of biochemical recurrence (BCR) in cases of pT2 prostate cancer (PC). Methods Retrospective analysis of all radical prostatectomy (RP) cases performed in the West of Scotland during the period from January 2013 to June 2022. Primary outcomes were PSM and BCR. The secondary outcomes compared the impact of centralisation and surgical approach on PSM and BCR; and margin length and location on BCR. Propensity score matching and Cox regression models were performed using R. Results A total of, 907 patients were included; 662 robot assisted radical prostatectomy (RARP), 245 open RP. PSM rate was 17.7% (161/907), similar in RARP and open cohorts. Patients with PSM had higher rates of BCR; 26.7%, compared to 8.7% in patients with no PSM. Patients with margins of ≥ 1 mm had higher risk of developing BCR. Patients who underwent open RP had increased incidence of PSM ≥ 1 mm; 40/43 (93%) compared to 83/117 (71%) in robotic approach (p = 0.003). Limitations include the study being retrospective, introduction of centralisation and robot concurrently, and evolution of practice. Discussion PSMs in pT2 PC are associated with higher rates of BCR. Introduction of centralisation via the robot had no impact on PSM occurrence or BCR, although did demonstrate a reduction in PSM length.https://doi.org/10.1002/cam4.70514biochemical recurrencepositive surgical marginprostate cancerradical prostatectomyrobotic surgery |
| spellingShingle | Ibrahim Ibrahim Omar Kouli Sanjana Ilangovan Melanie Sneddon Sarika Nalagatla Carol Marshall Lorenzo Dutto Hing Y. Leung Imran Ahmad Impact of Centralisation of Radical Prostatectomy Driven by the Introduction of Robotic Systems on Positive Surgical Margin and Biochemical Recurrence in pT2 Prostate Cancer Cancer Medicine biochemical recurrence positive surgical margin prostate cancer radical prostatectomy robotic surgery |
| title | Impact of Centralisation of Radical Prostatectomy Driven by the Introduction of Robotic Systems on Positive Surgical Margin and Biochemical Recurrence in pT2 Prostate Cancer |
| title_full | Impact of Centralisation of Radical Prostatectomy Driven by the Introduction of Robotic Systems on Positive Surgical Margin and Biochemical Recurrence in pT2 Prostate Cancer |
| title_fullStr | Impact of Centralisation of Radical Prostatectomy Driven by the Introduction of Robotic Systems on Positive Surgical Margin and Biochemical Recurrence in pT2 Prostate Cancer |
| title_full_unstemmed | Impact of Centralisation of Radical Prostatectomy Driven by the Introduction of Robotic Systems on Positive Surgical Margin and Biochemical Recurrence in pT2 Prostate Cancer |
| title_short | Impact of Centralisation of Radical Prostatectomy Driven by the Introduction of Robotic Systems on Positive Surgical Margin and Biochemical Recurrence in pT2 Prostate Cancer |
| title_sort | impact of centralisation of radical prostatectomy driven by the introduction of robotic systems on positive surgical margin and biochemical recurrence in pt2 prostate cancer |
| topic | biochemical recurrence positive surgical margin prostate cancer radical prostatectomy robotic surgery |
| url | https://doi.org/10.1002/cam4.70514 |
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