Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
BJU Int. 2010 Sep;106(5):622-6. doi: 10.1111/j.1464-410X.2009.09184.x.
To determine the effect of a deep and narrow pelvis on apical positive surgical margins (PSM) at radical prostatectomy (RP), controlling for other clinical and pathological variables and surgical approach, i.e. open retropubic (RRP) vs laparoscopic (LRP), as apical dissection is expected to be more challenging at RP with a prostate situated deep in a narrow pelvis.
From July 2003 to January 2005, 512 consecutive patients with preoperative prostate magnetic resonance imaging (MRI) underwent RRP or LRP with no previous radio- or hormonal therapy. An additional 74 patients with preoperative MRI undergoing RP from December 2001 to June 2007 who had an apical PSM were also included, with 586 patients comprising the study population. Bony and soft-tissue pelvic dimensions, including interspinous distance (ISD), bony (BFW) and soft tissue (SW) pelvic width, apical prostate depth (AD) and symphysis pubis angle, were measured on preoperative MRI. The pelvic dimension index (PDI), bony width index (BWI) and soft-tissue width index (SWI) were defined as ISD/AD, BFW/AD and SW/AD, respectively. Multivariate logistic regression was used to assess the effect of pelvic dimensions on apical PSM, controlling for surgical approach and clinical and pathological variables.
There was no significant difference in ISD, BFW, SW or symphysis angle between patients with and without apical PSM. The AD was significantly greater in men with an apical PSM and consequently PDI, BWI and SWI were significantly lower in men with an apical PSM. Each of PDI, AD, BWI and SWI was a significant independent predictor of apical PSM, independent of surgical approach, and other clinicopathological variables. The main limitations of the study were that it was retrospective, and the relatively few patients with apical PSM.
Apical prostate depth is an independent risk factor for apical PSM at RP. MRI pelvimetry might allow for preoperative planning of the approach to RP.
确定骨盆深度和狭窄对根治性前列腺切除术（RP）中尖部阳性手术切缘（PSM）的影响，同时控制其他临床和病理变量以及手术方法，即开放耻骨后（RRP）与腹腔镜（LRP），因为在前列腺位于骨盆深处且骨盆狭窄的情况下，RP 中进行尖部解剖预计会更具挑战性。
从 2003 年 7 月至 2005 年 1 月，512 例连续接受术前前列腺磁共振成像（MRI）检查的患者接受了 RRP 或 LRP，且均未接受过放射或激素治疗。此外，还纳入了 2001 年 12 月至 2007 年 6 月期间接受 RP 且术前 MRI 检查发现尖部 PSM 的 74 例患者，共有 586 例患者组成研究人群。在术前 MRI 上测量了骨盆的骨性和软组织尺寸，包括棘突间距离（ISD）、骨性（BFW）和软组织（SW）骨盆宽度、前列腺尖部深度（AD）和耻骨联合角度。定义骨盆尺寸指数（PDI）、骨性宽度指数（BWI）和软组织宽度指数（SWI）分别为 ISD/AD、BFW/AD 和 SW/AD。使用多变量逻辑回归评估了骨盆尺寸对尖部 PSM 的影响，同时控制了手术方法和临床及病理变量。
有尖部 PSM 和无尖部 PSM 的患者之间，ISD、BFW、SW 或耻骨联合角度无显著差异。有尖部 PSM 的患者 AD 显著更大，因此 PDI、BWI 和 SWI 显著更低。PDI、AD、BWI 和 SWI 均为尖部 PSM 的显著独立预测因子，独立于手术方法和其他临床病理变量。研究的主要局限性在于其为回顾性研究，且尖部 PSM 的患者相对较少。
前列腺尖部深度是 RP 中尖部 PSM 的独立危险因素。MRI 骨盆测量可能允许术前规划 RP 的手术方法。
