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Open Access Highly Accessed Research

Effects of robotic-assisted laparoscopic prostatectomy on surgical pathology specimens

Heng Hong1*, Lin Mel1, Jonathan Taylor2, Qiang Wu3 and Hugh Reeves2

Author Affiliations

1 Brody School of Medicine at East Carolina University, Greenville, NC, USA

2 Eastern Urological Associates, P.A., Greenville, NC, USA

3 College of Allied Health Sciences at East Carolina University, Greenville, NC, USA

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Diagnostic Pathology 2012, 7:24  doi:10.1186/1746-1596-7-24

Published: 13 March 2012

Abstract

Background

Robotic-assisted laparoscopic prostatectomy (RALP) has greatly changed clinical management of prostate cancer. It is important for pathologists and urologists to compare RALP with conventional open radical retropubic prostatectomy (RRP), and evaluate their effects on surgical pathology specimens.

Methods

We retrospectively reviewed and statistically analyzed 262 consecutive RALP (n = 182) and RRP (n = 80) procedures performed in our institution from 2007 to 2010. From these, 49 RALP and 33 RRP cases were randomly selected for additional microscopic examination to analyze the degree of capsular incision and the amount of residual prostate surface adipose tissue.

Results

Positive surgical margins were present in 28.6% RALP and 57.5% RRP cases, a statistically significant difference. In patients with stage T2c tumors, which represent 61.2% RALP and 63.8% RRP patients, the positive surgical margin rate was 24.1% in the RALP group and 58.8% in the RRP group (statistically significant difference). For other pathologic stages, the differences in positive margins between RALP and RRP groups were not statistically significant. The incidence of positive surgical margins after RALP was related to higher tumor stage, higher Gleason score, higher tumor volume and lower prostate weight, but was not related to the surgeons performing the procedure. When compared with RRP, RALP also caused less severe prostatic capsular incision and maintained larger amounts of residual surface adipose tissue in prostatectomy specimens.

Conclusions

In this study RALP showed a statistically significant lower positive surgical margin rate than RRP. Analysis of capsular incision and amount of prostatic surface residual adipose tissue suggested that RALP caused less prostatic capsular damage than RRP.

Virtual slides

The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1278078279667611 webcite

Keywords:
Robotic-assisted laparoscopic prostatectomy; Radical retropubic prostatectomy; Prostate cancer; Positive surgical margin; Capsular incision