Randomized trial comparing an anterograde versus a retrograde approach to open radical prostatectomy: results in terms of positive margin rate
Bibliographic record
Abstract
Objectives: Surgical technique, patient characteristics and methodof pathological review may influence surgical margin (SM) status.Positive surgical margin (SM+) rates of 14% to 46% have beenreported in different radical retropubic prostatectomy (RRP) series.We evaluated the effect of an anterograde versus retrograde approachto RRP and specifically focused on the incidence of SM+.Methods: From January 2003 to November 2007, we randomlyassigned 200 patients with clinically localized prostate adenocarcinomasto undergo a retrograde (Group A) versus an anterograde(Group B) open RRP. All RRPs were performed at our institutionby 2 surgeons. For all 200 patients, we evaluated a panelof clinical and pathological variables relating to their associationwith SM status.Results: In Group A, 22% of cases after RRP showed a pT3 tumourand 39% of cases with a Gleason score ≥7 (4+3); in Group B,20% of cases showed a pT3 tumour and 37% of cases with aGleason score ≥7 (4+3) (p > 0.10). The incidence of SM+ was18% in Group A and 14% in Group B (p = 0.0320). In Group A,22.2% of cases with SM+ had multiple positive margins, whereasno cases in Group B showed multiple SM+. Regarding the localizationof SM+, no difference was found between the 2 groups.In the multivariate analysis, only prostate-specific antigen(p = 0.0090 and p = 0.0020, respectively in the 2 groups) andpathological stage (p < 0.0001 in both groups) were significantand independently associated with SM+ occurrence.Conclusion: In our experience, the anterograde approach to openRRP is associated with lower SM+ rates and no risk of multipleSM+ when compared with the retrograde approach.Objectifs : La technique chirurgicale, les caractéristiques du patientet la méthode d’examen pathologique peuvent tous avoir un impactsur le statut des marges chirurgicales. Des taux de marges chirurgicalespositives de 14 à 46 % ont été notés lors de différentesséries de prostatectomies radicales rétropubiennes (PRR). Nousavons évalué l’effet d’un abord antérograde ou rétrograde, plusprécisément sur l’incidence des marges chirurgicales positives.Méthodologie: Entre janvier 2003 et novembre 2007, nous avonschoisi au hasard 200 patients porteurs d’un adénocarcinome prostatiquecliniquement localisé pour qu’ils subissent une PRR ouverterétrograde (groupe A) ou antérograde (groupe B). Toutes les PRRont été réalisées à notre établissement par deux chirurgiens. Pourchacun des 200 patients, nous avons évalué un ensemble de variablescliniques et pathologiques quant à leur lien avec le statutdes marges chirurgicales.Résultats : Dans le groupe A, 22 % des patients présentaient unetumeur pT3 et 39 %, un score de Gleason ≥ 7 (4+3) après la PRR;dans le groupe B, 20 % des patients présentaient une tumeur pT3et 37 %, un score de Gleason ≥ 7 (4+3) (p > 0,10). L’incidencedes marges chirurgicales positives était de 18 % dans le groupeA et de 14 % dans le groupe B (p = 0,0320). Dans le groupe A,22,2 % des cas de marges chirurgicales positives étaient des casmultiples, tandis qu’aucun des patients du groupe B n’avaient demarges chirurgicales positives multiples. Aucune différence n’aété notée entre les deux groupes concernant l’emplacement desmarges positives. Dans l’analyse multivariée, seuls l’antigène prostatiquespécifique (p = 0,0090 et p = 0,0020, respectivement,dans les deux groupes) et le stade pathologique (p < 0,0001 dansles deux groupes) étaient significatifs et liés de façon indépendanteà la présence de marges chirurgicales positives.Conclusion: Selon nos observations, l’abord antérograde est lié àdes taux inférieurs de marges chirurgicales positives et à un risquenul de charges chirurgicales positives multiples, en comparaisonavec l’abord rétrograde.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.005 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.003 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".