Paper - WANFANG MED ONLINE

You Position: Home > Paper

Treatment of the positive surgical margin following radical prostatectomy

( views:110, downloads:8 )

Author:: No author available

Journal Title:: CHINESE MEDICAL JOURNAL

Issue:: 4

DOI:: No doi available

Key Word:: positive surgical margin;prostate cancer;radical prostatectomy

Abstract： Objective With increased incidence of prostate cancer and an increased number of patients undergoing radical prostatectomy in China,it will be necessary to elaborate the diagnosis,clinical significance and treatment of patients whose tumors have positive surgical margins following radical prostatectomy.Data sources Positive surgical margin,prostate cancer and radical prostatectomy were used as subject words and the medical literature in recent decades was searched using the PubMed database and the results are summarized.Study selection Using positive surgical margin,prostate cancer and radical prostatectomy as subject words the PubMed medical database produced 275 papers of pertinent literature.By further screening 28 papers were selected and they represent relatively large-scale clinical randomized and controlled clinical trials.Results A pertinent literature of 275 papers was identified and 28 papers on large clinical studies were obtained.Analysis of results indicated that the positive rate of surgical margin after radical prostatectomy is 20%-40%,and although most patients with positive surgical margins are stable for a considerable period,the data available now suggested that the presence of a positive surgical margin will have an impact on the patient's prognosis.The risk factors of positive surgical margin include preoperative prostate specific antigen level,Gleason's score and pelvic lymph node metastasis.The most common site with positive surgical margin is in apical areas of the prostate;therefore surgical technique is also a factor resulting in positive surgical margins.From data available now it appears that as long as the surgical technique is skilled,different surgical modes do not affect the rate of surgical margin.Adjuvant radiotherapy is mainly used to treat patients with positive surgical margin after radical prostatectomy,but combination with androgen deprivation therapy may increase the curative effect.Conclusion The current data indicated that the presence of positive surgical margins can markedly affect the patient's prognosis.Therefore we should be aware how we reduce the positive surgical margin,how to diagnose positive surgical margin and how to treat when there are positive surgical margins.

Reference

[1]项永兵.中国恶性肿瘤高发现场点资料的分析和利用[J].2005,(9).
[2]徐志兵,王国民,孙立安,等.上海市市区前列腺癌发病情况调查分析[J].2003,(3).
[3]J I, Epstein.Incidence and significance of positive margins in radical prostatectomy specimens.[J].1996,23(4).
[4]Soares MA,Rubin MA,Gaston SM,etc.Tissue-print and print-phoresis as platform technologies for the molecular analysis of human surgical specimens: mapping tumor invasion of the prostate capsule.[J].2005,11(1).
[5]Plante P,Escourrou G,Pontonnier F,etc.Impact of a modified apical dissection during radical retropubic prostatectomy on the occurrence of positive surgical margins: a comparative study in 212 patients.[J].2001,58(2).
[6]Cangiano T,Klein E,Graefen M,etc.Prognostic impact of positive surgical margins in surgically treated prostate cancer: multi-institutional assessment of 5831 patients.[J].2005,66(6).
[7]H, Zincke,J E, Oesterling,M L, Blute,etc.Long-term (15 years) results after radical prostatectomy for clinically localized (stage T2c or lower) prostate cancer.[J].1994,152.
[8]Sternberg C,Pierart M,Storme G,etc.Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): a phase III randomised trial.[J].2002,360(9327).
[9]Ohori M,Eastham JA,Kattan MW,etc.Is intraoperative frozen section analysis an efficient way to reduce positive surgical margins?[J].2005,66(6).
[10]Bolla M,Scalliet P,Da Pozzo L,etc.Postoperative radiotherapy after radical prostatectomy: a randomised controlled trial (EORTC trial 22911).[J].2005,366(9485).
[11]Chang JJ,Miller DP,Carroll PR,etc.Does the completeness of prostate sampling predict outcome for patients undergoing radical prostatectomy?: data from the CAPSURE database.[J].2000,56(3).
[12]Troyer D,Lucia MS,Canby-Hagino E,etc.Adjuvant radiotherapy for pathologically advanced prostate cancer: a randomized clinical trial.[J].2006,296(19).
[13]Pistenmaa DA,Leibel SA,Roehrborn CG,etc.Salvage radiotherapy for recurrent prostate cancer after radical prostatectomy.[J].2004,291(11).
[14]P C, Walsh,A W, Partin,J I, Epstein.Cancer control and quality of life following anatomical radical retropubic prostatectomy: results at 10 years.[J].1994,152.
[15]Ward JF,Myers RP,Zincke H,etc.The impact of surgical approach (nerve bundle preservation versus wide local excision) on surgical margins and biochemical recurrence following radical prostatectomy.[J].2004,172(4 Pt.1).
[16]O'Reilly K,Sexton W,Chung A,etc.Early versus delayed hormonal therapy for prostate specific antigen only recurrence of prostate cancer after radical prostatectomy.[J].2004,171(3).
[17]Soloway MS,Simon MA,Kim S.Prostate specific antigen recurrence rates are low after radical retropubic prostatectomy and positive margins.[J].2006,175(1).
[18]Steel BL,Gaker DL.Radical prostatectomy with preservation of urinary continence: pathology and long-term results.[J].2004,172(6 Pt.2).
[19]Brendler CB,Alsikafi NF,Laven BA,etc.Minor modifications in apical dissection of radical retropubic prostatectomy in patients with clinical stage T2 prostate cancer reduce positive surgical margin incidence.[J].2004,63(1).
[20]Gerigk C,Gonen M,Eastham JA,etc.Variations among individual surgeons in the rate of positive surgical margins in radical prostatectomy specimens.[J].2003,170(6 Pt.1).