Radical retropubic prostatectomy. How often do experienced surgeons have positive surgical margins when there is extraprostatic extension in the region of the neurovascular bundle?
Identifieur interne : 006910 ( Main/Merge ); précédent : 006909; suivant : 006911Radical retropubic prostatectomy. How often do experienced surgeons have positive surgical margins when there is extraprostatic extension in the region of the neurovascular bundle?
Auteurs : David J. Hernandez [États-Unis] ; Jonathan I. Epstein [États-Unis] ; Bruce J. Trock [États-Unis] ; Toyonori Tsuzuki [États-Unis] ; H. Ballentine Carter [États-Unis] ; Patrick C. Walsh [États-Unis]Source :
- The Journal of urology [ 0022-5347 ] ; 2005.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Chirurgien, Décision.
English descriptors
- KwdEn :
Abstract
Purpose: We determined the frequency of positive surgical margins (PSMs) in patients with extraprostatic extension (EPE) in the region of the neurovascular bundle (NVB) who underwent open radical retropubic prostatectomy by 2 experienced surgeons. Materials and Methods: A total of 204 men with EPE in the region of the NVB underwent surgery by 2 experienced surgeons. The frequency of PSMs in the area of the NVB as well as the nerve sparing status of each lobe of the prostate were determined through a retrospective investigation of the pathology database as well as the physician's database. The recovery of sexual function was determined and compared to controls. Results: The age, clinical stage, biopsy Gleason sum and serum prostate specific antigen of the patients operated on by surgeons 1 and 2 were similar. Surgeon 1 widely excised at least 1 neurovascular bundle in 16% of the patients and surgeon 2 in 63%. The overall frequency of PSMs at the NVB was 5.9% for surgeon 1 and 5.8% for surgeon 2. Of the evaluable patients followed for 12 months or longer 83.5% of those operated on by surgeon 1 were potent compared to 63.8% of those operated on by surgeon 2. Conclusions: Visual and tactile assessment during open surgery by an experienced surgeon provides valuable information on when and where it is safe to preserve the neurovascular bundle in patients with EPE in the region of the NVB. Surgical approaches in which tactile sensation is muted or absent, laparoscopic and robotic, need to undergo a similar evaluation to determine whether magnification of the operative field is sufficient to overcome the lack of haptic feedback and ability to palpate the tissue.
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Epstein</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>James Buchanan Brady Urological Institute and The Department of Pathology, The Johns Hopkins Medical Institutions</s1><s2>Baltimore, Maryland</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Maryland</region></placeName></affiliation></author><author><name sortKey="Trock, Bruce J" sort="Trock, Bruce J" uniqKey="Trock B" first="Bruce J." last="Trock">Bruce J. 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Walsh</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>James Buchanan Brady Urological Institute and The Department of Pathology, The Johns Hopkins Medical Institutions</s1><s2>Baltimore, Maryland</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Maryland</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">05-0079063</idno><date when="2005">2005</date><idno type="stanalyst">PASCAL 05-0079063 INIST</idno><idno type="RBID">Pascal:05-0079063</idno><idno type="wicri:Area/PascalFrancis/Corpus">000F06</idno><idno type="wicri:Area/PascalFrancis/Curation">000602</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">000B00</idno><idno type="wicri:doubleKey">0022-5347:2005:Hernandez D:radical:retropubic:prostatectomy</idno><idno type="wicri:Area/Main/Merge">006910</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Radical retropubic prostatectomy. How often do experienced surgeons have positive surgical margins when there is extraprostatic extension in the region of the neurovascular bundle?</title><author><name sortKey="Hernandez, David J" sort="Hernandez, David J" uniqKey="Hernandez D" first="David J." last="Hernandez">David J. Hernandez</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>James Buchanan Brady Urological Institute and The Department of Pathology, The Johns Hopkins Medical Institutions</s1><s2>Baltimore, Maryland</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Maryland</region></placeName></affiliation></author><author><name sortKey="Epstein, Jonathan I" sort="Epstein, Jonathan I" uniqKey="Epstein J" first="Jonathan I." last="Epstein">Jonathan I. Epstein</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>James Buchanan Brady Urological Institute and The Department of Pathology, The Johns Hopkins Medical Institutions</s1><s2>Baltimore, Maryland</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Maryland</region></placeName></affiliation></author><author><name sortKey="Trock, Bruce J" sort="Trock, Bruce J" uniqKey="Trock B" first="Bruce J." last="Trock">Bruce J. Trock</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>James Buchanan Brady Urological Institute and The Department of Pathology, The Johns Hopkins Medical Institutions</s1><s2>Baltimore, Maryland</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Maryland</region></placeName></affiliation></author><author><name sortKey="Tsuzuki, Toyonori" sort="Tsuzuki, Toyonori" uniqKey="Tsuzuki T" first="Toyonori" last="Tsuzuki">Toyonori Tsuzuki</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>James Buchanan Brady Urological Institute and The Department of Pathology, The Johns Hopkins Medical Institutions</s1><s2>Baltimore, Maryland</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Maryland</region></placeName></affiliation></author><author><name sortKey="Carter, H Ballentine" sort="Carter, H Ballentine" uniqKey="Carter H" first="H. Ballentine" last="Carter">H. Ballentine Carter</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>James Buchanan Brady Urological Institute and The Department of Pathology, The Johns Hopkins Medical Institutions</s1><s2>Baltimore, Maryland</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Maryland</region></placeName></affiliation></author><author><name sortKey="Walsh, Patrick C" sort="Walsh, Patrick C" uniqKey="Walsh P" first="Patrick C." last="Walsh">Patrick C. Walsh</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>James Buchanan Brady Urological Institute and The Department of Pathology, The Johns Hopkins Medical Institutions</s1><s2>Baltimore, Maryland</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Maryland</region></placeName></affiliation></author></analytic><series><title level="j" type="main">The Journal of urology</title><title level="j" type="abbreviated">J. urol.</title><idno type="ISSN">0022-5347</idno><imprint><date when="2005">2005</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">The Journal of urology</title><title level="j" type="abbreviated">J. urol.</title><idno type="ISSN">0022-5347</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Anatomic pathology</term><term>Decision</term><term>Decision making</term><term>Extension</term><term>Nephrology</term><term>Prostate</term><term>Prostatectomy</term><term>Radical</term><term>Support</term><term>Surgeon</term><term>Surgical margin</term><term>Technique</term><term>Treatment</term><term>Tumor</term><term>Urology</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Radical</term><term>Prostatectomie</term><term>Chirurgien</term><term>Extension</term><term>Prostate</term><term>Tumeur</term><term>Anatomopathologie</term><term>Décision</term><term>Prise décision</term><term>Support</term><term>Technique</term><term>Urologie</term><term>Traitement</term><term>Paquet neurovasculaire</term><term>Marge chirurgicale</term><term>Néphrologie</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Chirurgien</term><term>Décision</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Purpose: We determined the frequency of positive surgical margins (PSMs) in patients with extraprostatic extension (EPE) in the region of the neurovascular bundle (NVB) who underwent open radical retropubic prostatectomy by 2 experienced surgeons. Materials and Methods: A total of 204 men with EPE in the region of the NVB underwent surgery by 2 experienced surgeons. The frequency of PSMs in the area of the NVB as well as the nerve sparing status of each lobe of the prostate were determined through a retrospective investigation of the pathology database as well as the physician's database. The recovery of sexual function was determined and compared to controls. Results: The age, clinical stage, biopsy Gleason sum and serum prostate specific antigen of the patients operated on by surgeons 1 and 2 were similar. Surgeon 1 widely excised at least 1 neurovascular bundle in 16% of the patients and surgeon 2 in 63%. The overall frequency of PSMs at the NVB was 5.9% for surgeon 1 and 5.8% for surgeon 2. Of the evaluable patients followed for 12 months or longer 83.5% of those operated on by surgeon 1 were potent compared to 63.8% of those operated on by surgeon 2. Conclusions: Visual and tactile assessment during open surgery by an experienced surgeon provides valuable information on when and where it is safe to preserve the neurovascular bundle in patients with EPE in the region of the NVB. Surgical approaches in which tactile sensation is muted or absent, laparoscopic and robotic, need to undergo a similar evaluation to determine whether magnification of the operative field is sufficient to overcome the lack of haptic feedback and ability to palpate the tissue.</div></front></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>Maryland</li></region></list><tree><country name="États-Unis"><region name="Maryland"><name sortKey="Hernandez, David J" sort="Hernandez, David J" uniqKey="Hernandez D" first="David J." last="Hernandez">David J. Hernandez</name></region><name sortKey="Carter, H Ballentine" sort="Carter, H Ballentine" uniqKey="Carter H" first="H. Ballentine" last="Carter">H. Ballentine Carter</name><name sortKey="Epstein, Jonathan I" sort="Epstein, Jonathan I" uniqKey="Epstein J" first="Jonathan I." last="Epstein">Jonathan I. Epstein</name><name sortKey="Trock, Bruce J" sort="Trock, Bruce J" uniqKey="Trock B" first="Bruce J." last="Trock">Bruce J. Trock</name><name sortKey="Tsuzuki, Toyonori" sort="Tsuzuki, Toyonori" uniqKey="Tsuzuki T" first="Toyonori" last="Tsuzuki">Toyonori Tsuzuki</name><name sortKey="Walsh, Patrick C" sort="Walsh, Patrick C" uniqKey="Walsh P" first="Patrick C." last="Walsh">Patrick C. Walsh</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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