Analysis Of Preoperative Factors For Positive Surgical Margin And Urinary Continence Recovery After Robot-assisted Laparoscopic Radical Prostatectomy

PurposeTo evaluate the incidence of positive surgical margin and urinary continence after robot-assisted laparoscopic radical prostatectomy(RARP)and identify the preoperative predictors for positive surgical margin and continence recovery.MethodsClinical data of patients who underwent transabdominal RARP by a single surgeon were retrospectively collected in the First Affiliated Hospital of Zhengzhou University from October 2014 to September 2019.The incidence of positive surgical margin and urinary continence after RARP were evaluated,and the factors affecting the positive surgical margin and continence recovery after RARP were analyzed by logistic regression analysis and Cox regression analysis,respectively.ResultsThe overall positive surgical margin rate was 34%.The estimated rates for apical,posterolateral,basal,and multifocal positive surgical margin were 8%,4%,7%,and 14%,respectively.Continence rate at 1,3,6,12 and 24 months after RARP was 22%,44%,72%,89%and 89%,respectively.In univariate logistic regression analysis,overall positive surgical margin related to tPSA,f/tPSA,percentage of positive needles,and Gleason score.Multifocal positive surgical margin correlated with smoking history,drinking history,tPSA,f/tPSA,percentage of positive needles,and Gleason score.In Multivariate logistic regression analysis,percentage of positive needles reminded the only independent predictor for overall(OR=10.5,95%CI:2.58-44,4),and basal positive surgical margin(OR=26.0,95%CI:2.02-335).The f/tPSA(OR=2.59,95%CI:2.18-5.71)and percentage of positive needles(OR=31.0,95%CI:3.17-303)were independent risk factors for multifocal positive surgical margin.Univariate Cox regression analysis showed that transurethral resection of the prostate(TURP),diabetes mellitus and hypertension could significantly delay the urinary continence recovery.Multivariate Cox regression analysis showed that TURP(HR=0.68,95%CI:0.51-0.92)and diabetes mellitus(HR=0.66,95%CI:0.47-0.92)were independent risk factors of urinary continence recovery.Conclusion1.The positive surgical margin rate was higher among Chinese population undergoing RARP,compared Western population.The multifocal sites were the most common location of positive surgical margin,followed by apical and basal sites among Chinese patients undergoing RARP.2.The percentage of positive needles was the independent risk factor for overall and basal positive surgical margin.The f/tPSA and percentage of positive needles were significantly independent risk factors of multifocal positive surgical margin.3.Urinary continence improves gradually within 1 year after RARP,and achieves stability after 12 months.TURP and diabetes are independent risk factors influencing the recovery of urinary continence.