Serni S, Masieri L, Lapini A, Nesi G, Carini M
Department of Urology, University of Florence, Santa Maria Annunziata Hospital, Florence, Italy.
BJU Int. 2004 Feb;93(3):279-83. doi: 10.1111/j.1464-410x.2004.04602.x.
To evaluate the incidence of positive surgical margins (and associated risk factors) in patients with localized prostate cancer at high preoperative risk of extracapsular disease treated using a modified anterograde radical retropubic prostatectomy technique. Positive surgical margins are an important risk factor for disease recurrence after radical prostatectomy, particularly in patients with extracapsular disease.
In total, 84 patients with clinically localized prostate cancer and a preoperative prostate-specific antigen (PSA) level > 10 ng/mL and/or a biopsy Gleason score > or = 7 were evaluated. The surgical technique allows easy, wide resection of the posterolateral prostatic pedicles, and good mobilization and exposure of the apex before the urethra transection. Prostatectomy specimens were examined for extracapsular tumour spread and positive surgical margins. Differences in putative risk factors (Gleason score, preoperative PSA level, prostate weight) between the positive- and negative-margin groups were evaluated using the Mann-Whitney test.
Overall, 11 of the 84 (13%) patients had positive surgical margins and of these a single site was involved in six. In total, 15 positive-margin sites were identified (five apical, four basal, three posterolateral, two anterior and one posterior). All patients with positive margins had histological extracapsular disease. The preoperative PSA level and Gleason score were significantly higher in the positive- than in the negative-margin group (P = 0.025 and 0.035, respectively).
The anterograde radical prostatectomy minimizes the incidence of positive surgical margins in patients at high risk of extracapsular disease.
采用改良顺行耻骨后根治性前列腺切除术技术，评估术前存在高风险包膜外疾病的局限性前列腺癌患者手术切缘阳性（及相关危险因素）的发生率。手术切缘阳性是根治性前列腺切除术后疾病复发的重要危险因素，尤其在存在包膜外疾病的患者中。
共评估了84例临床局限性前列腺癌患者，其术前前列腺特异性抗原（PSA）水平>10 ng/mL和/或活检Gleason评分>或=7。该手术技术便于轻松、广泛地切除前列腺后外侧蒂，并在横断尿道前良好地游离和暴露前列腺尖部。对前列腺切除标本进行包膜外肿瘤扩散和手术切缘阳性情况检查。采用Mann-Whitney检验评估切缘阳性组和阴性组之间假定危险因素（Gleason评分、术前PSA水平、前列腺重量）的差异。
总体而言，84例患者中有11例（13%）手术切缘阳性，其中6例仅累及单个部位。总共确定了15个切缘阳性部位（5个尖部、4个基部、3个后外侧、2个前部和1个后部）。所有切缘阳性患者均有组织学包膜外疾病。切缘阳性组的术前PSA水平和Gleason评分显著高于切缘阴性组（分别为P = 0.025和0.035）。
顺行根治性前列腺切除术可将包膜外疾病高风险患者手术切缘阳性的发生率降至最低。
