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Prognostic Significance of Surgical Margin Status after Laparoscopic Radical Prostatectomy: Early Experience in a Single Institution in Japan

Objective: The objective of this study was to evaluate the impact of surgical margin status on biochemical recurrence after laparoscopic radical prostatectomy (LRP). Patients and Methods: This study included a total of 159 patients with clinically organ-confined prostate cancer who underwent LRP without any neo-adjuvant therapies between October 2000 and June 2006. The influence of the number of positive surgical margins as well as their location, which were divided into apex, posterior site, anterior site and bladder neck, on biochemical recurrence in these 159 patients was retrospectively analyzed. Results: Surgical margins were positive in 57 patients (35.8%), of whom 32 (56.1%) and 25 (43.9%) had organ-confined disease (OCD) and non-OCD, respectively. Of these 57 patients, 36 (63.2%) and 21 (36.8%) had solitary and multiple positive margins, respectively. The locations of positive surgical margins in LRP specimens from these 57 patients were as follows: 37 (64.9%) at the apex, 8 (14.0%) at the anterior site, 14 (24.6%) at the posterior site and 21 (36.8%) at the bladder neck. During the observation period of this study (median, 38 months), biochemical recurrence developed in 31/159 (19.5%) patients. On multivariate analysis, serum value of prostate specific antigen and positive surgical margin were independently associated with biochemical recurrence, irrespective of other factors examined. When the impact of the number of positive surgical margins and their location on biochemical recurrence was evaluated by multivariate analysis, the positive apex and bladder neck margins were identified as independent predictors of biochemical recurrence in overall patients, while the positive surgical margin at the apex and that at the bladder neck were independently related to biochemical recurrence in patients with OCD and non-OCD, respectively. Conclusion: These findings suggest that surgical margin status plays a crucial role in biochemical progression following LRP, and that a positive surgical margin at the apex and bladder neck could be useful predictors of biochemical recurrence in patients with OCD and non-OCD, respectively.