Zero positive surgical margins after radical prostatectomy: is the end in sight?

Abstract

Positive surgical margins represent incomplete resection by the surgeon, and elimination of positive margins represents the only clinical feature during radical prostatectomy that can lead directly to improved cancer outcomes. The introduction of new robot-assisted technology and technical refinements has led to declines of positive surgical margins. Although margins induced by incomplete cancer resection by the surgeon have been reduced for organ-confined disease, the ‘Holy Grail’ of zero margins is not yet attainable in prostatectomy, and is more problematic in cancer that has penetrated beyond the prostate. Intraoperative frozen biopsies are imprecise. The union of real-time optical coherence tomography technology to the da Vinci^® robotic platform for identification of positive margin sites, and technical advances with wider excisions during surgery may provide promise for further reduction of surgical margins to zero.

Keywords::

• laparoscopic radical prostatectomy
• OCT
• optical coherence tomography
• prostate cancer
• robotic
• surgical margin

Financial & competing interests disclosure

Thomas E Ahlering is a Proctor and Consultant for Intuitive Surgical, Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.