PD43-02 THE IMPACT OF CASE ORDER ON POSITIVE SURGICAL MARGINS FOR PROSTATE CANCER: A MULTI-INSTITUTIONAL ANALYSIS (2020)

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II (PD43)1 Apr 2020PD43-02 THE IMPACT OF CASE ORDER ON POSITIVE SURGICAL MARGINS FOR PROSTATE CANCER: A MULTI-INSTITUTIONAL ANALYSIS Laura Bukavina, MD MPH* Kirtishri Mishra, MD Amr Mahran, MD MS Sarah Markt, ScD MPH Fredrick Schumacher, PhD MPH Britt Conroy, MD PhD JD MS Robert Abouassaly, MD MS Gregory MacLennan, MD Garrett Smith, MD Elizabeth Ferry, MD Daniel Wong, MS Yair Lotan, MD Claus Roehrborn, MD David Sharp, MD Chaparala Hemant, MD Nayan Shah, BS Kareem Alazem, MD Ali Moinzadeh, MD, Burlington, MA Brittany Adamic, MD Gregory Zagaya, MD Puneet Kang, BS Holly Lawry, BS Benjamin Lee, MD Adam Callaway, MD MPH Jason Jankowski, andMD Lee PonskyMD Laura BukavinaLaura Bukavina More articles by this author , Kirtishri MishraKirtishri Mishra More articles by this author , Amr MahranAmr Mahran More articles by this author , Sarah MarktSarah Markt More articles by this author , Fredrick SchumacherFredrick Schumacher More articles by this author , Britt ConroyBritt Conroy More articles by this author , Robert AbouassalyRobert Abouassaly More articles by this author , Gregory MacLennanGregory MacLennan More articles by this author , Garrett SmithGarrett Smith More articles by this author , Elizabeth FerryElizabeth Ferry More articles by this author , Daniel WongDaniel Wong More articles by this author , Yair LotanYair Lotan More articles by this author , Claus RoehrbornClaus Roehrborn More articles by this author , David SharpDavid Sharp More articles by this author , Chaparala HemantChaparala Hemant More articles by this author , Nayan ShahNayan Shah More articles by this author , Kareem AlazemKareem Alazem More articles by this author , Ali MoinzadehAli Moinzadeh More articles by this author , Brittany AdamicBrittany Adamic More articles by this author , Gregory ZagayaGregory Zagaya More articles by this author , Puneet KangPuneet Kang More articles by this author , Holly LawryHolly Lawry More articles by this author , Benjamin LeeBenjamin Lee More articles by this author , Adam CallawayAdam Callaway More articles by this author , Jason JankowskiJason Jankowski More articles by this author , and Lee PonskyLee Ponsky More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000930.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Our aim was to evaluate whether sequential surgeries result in worse outcomes, such as positive surgical margins (PSM), in patients undergoing robotic-assisted laparoscopic prostatectomy (RALP), by comparing the second surgery to the first. METHODS: We retrospectively analyzed 898 RALP cases (449 sequential pairs) across eight institutions, from 1/1/2015-07/1/2018. Pooling the data across eight institutions, we calculated odds ratio (OR) and 95% confidence intervals (95% CI) using multivariable logistic regression models, adjusting for age, BMI, PSA, Grade, Tumor Involvement, EPE, and SVI, modeling PSM as the dependent variable, and case sequence as the independent variable of interest. Due to potential heterogeneity between institutions, we then conducted a meta-analysis to calculate a random-effects OR . RESULTS: A total of 898 RALP cases were included in this study, across 8 institutions. There were no differences between the first and the second cases of the day in PSA (6.2 ng/mL vs 6.3 ng/ml) total lymph node yield (12.0 vs. 11.0), seminal vesicle invasion (49% vs 52%), operative time (216.0 mins vs 220.0 mins), BMI (28.4 kg/m2 vs 28.6 kg/m2), prostate volume (45.1 g vs 45.2 g) and positive surgical margin rate (n=121 vs n=135). The second case of the day more likely to have higher prostatic involvement (p= 0.02), as well as higher blood loss (p= 0.25). In multivariable models, there were no differences in positive surgical margin (PSM) between the first and the second cases of the day. However, SVI (OR 1.92), EPE (OR 2.05), tumor involvement (OR 1.03), PSA (OR 1.02) as well as individual institution were statistically significantly associated with an increased risk of positive surgical margin. CONCLUSIONS: Data from our multi-institutional study suggests no statistically significant difference in lymph node yield, operative time, or PSM between the first and the second RALP of the day. Despite the lack of statistical significance by conventional parameters, there is a strong trend for increased rate of PSM in the second prostatectomy of the day in select patients. Disease specific factors such as EPE, SVI, PSA, tumor involvement as well as institutional experience are all associated with increased risk for positive surgical margin. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e899-e900 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Laura Bukavina More articles by this author Kirtishri Mishra More articles by this author Amr Mahran More articles by this author Sarah Markt More articles by this author Fredrick Schumacher More articles by this author Britt Conroy More articles by this author Robert Abouassaly More articles by this author Gregory MacLennan More articles by this author Garrett Smith More articles by this author Elizabeth Ferry More articles by this author Daniel Wong More articles by this author Yair Lotan More articles by this author Claus Roehrborn More articles by this author David Sharp More articles by this author Chaparala Hemant More articles by this author Nayan Shah More articles by this author Kareem Alazem More articles by this author Ali Moinzadeh More articles by this author Brittany Adamic More articles by this author Gregory Zagaya More articles by this author Puneet Kang More articles by this author Holly Lawry More articles by this author Benjamin Lee More articles by this author Adam Callaway More articles by this author Jason Jankowski More articles by this author Lee Ponsky More articles by this author Expand All Advertisement PDF downloadLoading ...