Margem cirúrgica positiva e recidiva bioquímica em pacientes submetidos a três técnicas de prostatectomia radical: aberta retrógrada, aberta anterógrada e assistida por robô

Abstract

Objective: This study aims to evaluate the relationship between positive surgical margin and biochemical failure among three radical prostatectomy techniques: open retrograde (ORP), open anterograde (AORP), and robot-assisted laparoscopic prostatectomy (RARP), in patients with pathological stage T2. Methods: The study evaluated 216 patients with localized prostate cancer (stage T2) who underwent radical prostatectomy between 2016 and 2022, divided into three groups according to the surgical technique used. Clinical and pathological data, including age, PSA, and Gleason score, were collected. The presence of positive surgical margin and perineural invasion was analyzed. Postoperative follow-up included monitoring for biochemical failure, defined as either PSA persistence or biochemical recurrence within two years. Results: Patients in the RARP group were significantly younger than those in the ORP and AORP groups (p = 0.003) and had a higher prevalence of low-risk classification according to D’Amico (p = 0.034). The incidence of positive surgical margins (PSM) was significantly higher in the ORP group (39.4%) compa-red to the RARP (24.1%; p = 0.039) and AORP groups (19.0%; p = 0.012). The urethral margin was significantly lower in the AORP group (p = 0.041) compared to the other two techniques. No statistically significant differences were observed regarding PSA persistence. In terms of biochemical recurrence within two years, there was no significant difference in the ORP (p = 0.121) and AORP (p = 1.00) groups; however, in the RARP group, a statistically significant association was found between positive surgical margin and biochemical recurrence (p = 0.021). Conclusion: The anterograde prostatectomy technique, regardless of whether it was performed via open surgery or with robotic assistance, showed a lower rate of positive surgical margins compared to the open retrograde approach.