INTRODUCTION AND OBJECTIVES:

To analyze the risk of positive margins (PSM) after radical prostatectomy in patients
undergoing robotic surgery (robotic assisted laparoscopic prostatectomy, RALP) compared
with those undergoing open surgery (open retropubic prostatectomy, ORP).

METHODS:
Consultation of an institutional database that since 2008 stores the data of 661 patients
submitted to prostatectomy. The patients who had neoadjuvant hormonal therapy (66
patients) or without complete information about margin status (19) were excluded. A
univariable and multivariable logistic regression was performed to evaluate the factors
related to PSM.
RESULTS:
576 patients were included in the study, 285 OP and 291 RALP. The characteristics of the
patients are described in table 1. The PSM overall rate was 28.1% (162/414 patients, pts);
20.6% in pT2 cases, 51.8% in >pT2; PSM rate for OP vs RALP was 31.9% vs 24.4 % (p=
0.044).
The factors that showed a correlation with the a PSM were: stage pT3a (relative risk, RR
4.149, p=0.001); Gleason score >=7 (RR 2.863, p=0.001); volume of cancer as
percentage of prostate volume (RR 1.031, p=0.001); surgical approach (RALP vs OP, RR
0.688, p=0.045); nerve sparing procedure (RR 0.641, p=0.019). At multivariable analysis,
maintained a significant correlation with the risk of PSM the presence of extra capsular
tumor (RR 2.979, p=0.001); Gleason score >=7 (RR 1.662, p=0.026); volume of cancer
(1.019, p=0.008) and surgical technique (RALP vs OP, RR 0.647, p=0.039).

CONCLUSIONS:
The RALP is emerging on the OP, thanks to a proven advantage in the post-operative
course and the possible benefits on the recovery of continence and erectile functions.
The oncological outcome of the two technique is considered as equivalent, although some
studies suggest a lower PSM rate for RALP.
This study evaluates a medium case-load institution, and compare an initial experience of
RALP, performed by surgeon without previous experience of prostatectomy, with a series
of OP performed by experienced surgeon. Our analysis shows that the risk of PSM is lower
for RALP, also adjusting the data for local staging, tumor volume and the final Gleason
score, that proved to be independent predictive factors for PSM.
In conclusion RALP allows a lower rate of PSM compared to OP, also in an initial
experience and with naive surgeons.