Impact of a modified apical dissection during radical retropubic prostatectomy on the occurrence of positive surgical margins: A comparative study in212 patients

Objectives. To assess the impact of a modified technique of apical dissecti on during radical retropubic prostatectomy on the occurrence of positive su rgical margins (PSMs). Methods. Between 1992 and 1998, 212 nonconsecutive patients with localized prostate cancer (57 T1, 155 T2) underwent radical retropubic prostatectomy and were divided into two groups: group 1, 85 patients who underwent surger y before January 1994; and group 2, 127 patients who underwent surgery with the modification of the apical dissection after January 1994. The modified technique consisted of a wide excision of periprostatic soft tissue at the apex, including the bilateral neurovascular bundles. The clinical data (ag e, prostate-specific antigen, clinical staging) and pathologic findings (pa thologic staging, Gleason score, PSM rate) of the two groups were compared. Results. No significant difference was found between the two groups regardi ng the median prostate-specific antigen level (10.8 ng/mL and 9.5 ng/mL), G leason score, and pathologic staging. Overall, the PSM rate was 53% in grou p 1 and 20.5% in group 2 (P <0.001). The number of PSMs decreased 2.6-fold in group 2. The PSM rate was significantly reduced at the apex with the new technique (group 1, 33.3%; group 2, 7.7%; P = 0.008). The PSM rate express ed with the odds ratio was 4.4-fold lower for patients in group 2 than for those in group 1. Conclusions. The modified apical dissection in radical retropubic prostatec tomy significantly improves the PSM rate in patients with localized T1-T2 p rostate cancer, UROLOGY 58: 217-221, 2001. (C) 2001, Elsevier Science Inc.