Surgical margins and biochemical recurrence after the introduction of robot-assisted radical prostatectomy.
8 affiliations
- 1Faculty of Medicine, Bydgoszcz University of Science and Technology, Bydgoszcz, Poland.
- 2Clinical Department of Oncology, Franciszek Łukaszczyk Oncology Center, Bydgoszcz, Poland.
- 3Department of Tumor Pathology and Pathomorphology, Franciszek Łukaszczyk Oncology Centre, Bydgoszcz, Poland.
- 4Doctoral School of Medical and Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland.
- 5Department of Obstetrics, Gynecology, and Oncology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland.
- 6Department of Urology, Franciszek Łukaszczyk Oncology Center, Bydgoszcz, Poland.
- 7Department of Oncological Surgery, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland.
- 8Chair of Pathology, Jan Biziel University Hospital No. 2 in Bydgoszcz, Poland.
Abstract
Introduction
The DaVinci System is increasingly introduced in many centers worldwide, creating a need for data on surgical outcomes during the early phase of adoption. This study analyzes positive surgical margins (PSMs) and compares outcomes between open, laparoscopic, and robot-assisted radical prostatectomy.Material and methods
We retrospectively analyzed histopathologic and clinical data from 153, 126, and 721 patients who underwent open, laparoscopic, and robot-assisted radical prostatectomy, respectively. Patients with T2-T3 disease, no lymph node or distant metastases, and no history of neoadjuvant or adjuvant therapy were included. Additionally, surgeon-specific learning curves based on PSM rates were evaluated following the introduction of robot-assisted radical prostatectomy at our institution.Results
PSM were identified in 254 of 721 (35.2%) robot-assisted procedures, predominantly as focal margins, most often located at the apex. PSM rates were comparable between robot-assisted and laparoscopic surgery and higher after open prostatectomy (p = 0.002). PSM distribution was similar between robot-assisted and open approaches, while apical margins were most frequent following laparoscopic prostatectomy. PSMs were associated with a higher risk of early biochemical recurrence in the entire cohort (p = 0.003). Seminal vesicle invasion was consistently associated with early biochemical recurrence across all surgical approaches. Robot-assisted and laparoscopic surgery were associated with a lower risk of early biochemical recurrence than open prostatectomy. Surgeon-specific analysis demonstrated heterogeneous learning curves, with a reduction in PSM rates after the initial 50-100 cases and stabilization with increasing experience.Conclusions
Robot-assisted radical prostatectomy achieved PSM rates comparable to laparoscopic and lower than open prostatectomy during the early phase following its introduction. Despite more adverse pathology, robot-assisted surgery was not associated with an increased early biochemical recurrence, supporting its oncologic safety during adoption. These findings reflect the real-world learning curve associated with the implementation of robotic surgery.
Related
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- Transformer-Based Deep Learning Integrating Multi-Regional MRI and Clinical Features for Predicting Biochemical Recurrence After Radical Prostatectomy: A Multicenter Study.
- Salvage radiotherapy with or without hormonal therapy for biochemical recurrence after radical prostatectomy: A systematic review and meta-analysis
BibTeX
@article{borowczak2026surgical,
title = {{Surgical margins and biochemical recurrence after the introduction of robot-assisted radical prostatectomy.}},
author = {Jędrzej Borowczak and Justyna Durślewicz and Mateusz Maniewski and Krzysztof Kamecki and Krzysztof Koper and Łukasz Szylberg},
journal = {Central European journal of urology},
year = {2026},
month = may,
doi = {10.5173/ceju.2026.0032},
url = {https://europepmc.org/article/MED/42903951},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Surgical margins and biochemical recurrence after the introduction of robot-assisted radical prostatectomy.
AU - Jędrzej Borowczak
AU - Justyna Durślewicz
AU - Mateusz Maniewski
AU - Krzysztof Kamecki
AU - Krzysztof Koper
AU - Łukasz Szylberg
PY - 2026
DA - 2026/05/15
JO - Central European journal of urology
DO - 10.5173/ceju.2026.0032
UR - https://europepmc.org/article/MED/42903951
AB - Introduction The DaVinci System is increasingly introduced in many centers worldwide, creating a need for data on surgical outcomes during the early phase of adoption. This study analyzes positive surgical margins (PSMs) and compares outcomes between open, laparoscopic, and robot-assisted radical prostatectomy.Material and methods We retrospectively analyzed histopathologic and clinical data from 153, 126, and 721 patients who underwent open, laparoscopic, and robot-assisted radical prostatectomy, respectively. Patients with T2-T3 disease, no lymph node or distant metastases, and no history of neoadjuvant or adjuvant therapy were included. Additionally, surgeon-specific learning curves based on PSM rates were evaluated following the introduction of robot-assisted radical prostatectomy at our institution.Results PSM were identified in 254 of 721 (35.2%) robot-assisted procedures, predominantly as focal margins, most often located at the apex. PSM rates were comparable between robot-assisted and laparoscopic surgery and higher after open prostatectomy (p = 0.002). PSM distribution was similar between robot-assisted and open approaches, while apical margins were most frequent following laparoscopic prostatectomy. PSMs were associated with a higher risk of early biochemical recurrence in the entire cohort (p = 0.003). Seminal vesicle invasion was consistently associated with early biochemical recurrence across all surgical approaches. Robot-assisted and laparoscopic surgery were associated with a lower risk of early biochemical recurrence than open prostatectomy. Surgeon-specific analysis demonstrated heterogeneous learning curves, with a reduction in PSM rates after the initial 50-100 cases and stabilization with increasing experience.Conclusions Robot-assisted radical prostatectomy achieved PSM rates comparable to laparoscopic and lower than open prostatectomy during the early phase following its introduction. Despite more adverse pathology, robot-assisted surgery was not associated with an increased early biochemical recurrence, supporting its oncologic safety during adoption. These findings reflect the real-world learning curve associated with the implementation of robotic surgery.
SN - 2080-4806
SN - 2080-4873
ER -