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논문 기본 정보

자료유형
학술저널
저자정보
Ryu Jae Hyun (Department of Urology Veterans Health Service Medical Center Seoul Korea.) Kim Yun Beom (Department of Urology Veterans Health Service Medical Center Seoul Korea.) Jung Tae Young (Department of Urology Veterans Health Service Medical Center Seoul Korea.) Ko Woo Jin (Department of Urology National Health Insurance Service Ilsan Hospital Goyang Korea.) Kim Sun Il (Department of Urology Ajou University School of Medicine Suwon Korea.) Kwon Dongdeuk (Department of Urology Chonnam National University Medical School Gwangju Korea.) Kim Duk Yoon (Department of Urology Catholic University of Daegu School of Medicine Daegu Korea.) Oh Tae Hee (Department of Urology Samsung Changwon Hospital Sungkyunkwan University School of Medicine Changwon) Yoo Tag Keun (Department of Urology Nowon Eulji Medical Center Eulji University School of Medicine Seoul Korea.)
저널정보
대한의학회 Journal of Korean Medical Science Journal of Korean Medical Science Vol.36 No.41
발행연도
2021.10
수록면
1 - 18 (18page)
DOI
10.3346/jkms.2021.36.e256

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Background: There is no clear consensus on the optimal treatment with curative intent for patients with positive surgical margins (PSMs) following radical prostatectomy (RP). The aim of this study was to investigate the perceptions and treatment patterns of Korean urologists regarding the resection margin after RP. Methods: A preliminary questionnaire was prepared by analyzing various studies on resection margins after RP. Eight experienced urologists finalized the 10-item questionnaire. In July 2019, the final questionnaire was delivered via e-mail to 105 urologists in Korea who specialize in urinary cancers. Results: We received replies from 91 of the 105 urologists (86.7%) in our sample population. Among them, 41 respondents (45.1%) had performed more than 300 RPs and 22 (24.2%) had completed 500 or more RPs. In the question about whether they usually performed an additional biopsy beyond the main specimen, to get information about surgical margin invasion during surgery, the main opinion was that if no residual cancer was suspected, it was not performed (74.7%). For PSMs, the Gleason score of the positive site (49.5%) was judged to be a more important prognostic factor than the margin location (18.7%), multifocality (14.3%), or margin length (17.6%). In cases with PSMs after surgery, the prevailing opinion on follow-up was to measure and monitor prostate-specific antigen (PSA) levels rather than to begin immediate treatment (68.1%). Many respondents said that they considered postoperative radiologic examinations when PSA was elevated (72.2%), rather than regularly (24.4%). When patients had PSMs without extracapsular extension (pT2R1) or a negative surgical margin with extracapsular extension (pT3aR0), the response ‘does not make a difference in treatment policy’ prevailed at 65.9%. Even in patients at high risk of PSMs on preoperative radiologic screening, 84.6% of the respondents said that they did not perform neoadjuvant androgen deprivation therapy. Most respondents (75.8%) indicated that they avoided nerve-sparing RP in cases with a high risk of PSMs, but 25.7% said that they had tried nerve-sparing surgery. Additional analyses showed that urologists who had performed 300 or more prostatectomies tended to attempt more nerve-sparing procedures in patients with a high risk of PSMs than less experienced surgeons (36.6% vs. 14.0%; P = 0.012). Conclusion: The most common response was to monitor PSA levels without recommending any additional treatment when PSMs were found after RP. Through this questionnaire, we found that the perceptions and treatment patterns of Korean urologists differed considerably according to RP resection margin status. Refined research and standard practice guidelines are needed.
#Positive Surgical Margins #Practice Patterns #Clinical #Prostatectomy #Urologists

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참고문헌 (68)

참고문헌 신청
Sooriakumaran P / 2014 / A multinational, multi-institutional study comparing positive surgical margin rates among 22393 open, laparoscopic, and robot-assisted radical prostatectomy patients / Eur Urol 66(3):450~456 google schola Preisser F / 2019 / Rates of positive surgical margins and their effect on cancer-specific mortality at radical prostatectomy for patients with clinically localized prostate cancer / Clin Genitourin Cancer 17(1):e130~e139 google schola Wieder JA / 1998 / Incidence, etiology, location, prevention and treatment of positive surgical margins after radical prostatectomy for prostate cancer / J Urol 160(2):299~315 google schola Epstein JI / 1996 / Incidence and significance of positive margins in radical prostatectomy specimens / Urol Clin North Am 23(4):651~663 google schola Tan PH / 2011 / International Society of Urological Pathology (ISUP) consensus conference on handling and staging of radical prostatectomy specimens. Working group 5: surgical margins / Mod Pathol 24(1):48~57 google schola

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