Predictors of positive surgical margins after robot-assisted radical prostatectomy. A prospective cohort study and a systematic review with meta-analysis.
6 affiliations
- 1Department of Urology, James Cook University Hospital, Middlesbrough, United Kingdom.
- 2Department of Urology, North Tees University Hospital, Stockton, United Kingdom.
- 3Department of Urology, University Hospitals Birmingham, United Kingdom.
- 4Department of Urology, Freeman Hospital, Newcastle, United Kingdom.
- 5Department of Urology, Faculty of Medicine, Zagazig University, Egypt.
- 6Department of Urology, National Institute of Urology and Nephrology in Cairo, Egypt.
Abstract
Introduction
Positive surgical margins (PSMs) after robot-assisted laparoscopic radical prostatectomy (RALRP) are linked to increased biochemical recurrence risk, but predictors remain inconsistent. This study aimed to identify predictors of PSM through a prospective cohort analysis and a systematic review with meta-analysis.Material and methods
We analyzed 100 consecutive patients undergoing RALRP at a tertiary centre (2016-2018). Logistic regression assessed associations between clinical, pathological, and surgical variables and PSM. Cox regression evaluated the impact of PSM on biochemical recurrence. In parallel, a meta-analysis of studies reporting regression-based predictors of PSM after RALRP was conducted. Random-effects models pooled adjusted and unadjusted odds ratios.Results
In the cohort, 22% of patients had PSM, most frequently at the apex. Lower prostate weight was the only independent predictor of PSM (OR = 0.964 per gram; 95% CI: 0.95-0.98). PSM independently predicted biochemical recurrence (HR = 5.29; 95% CI: 1.38-20.19). The meta-analysis of 13 studies confirmed significant associations between PSM and higher pathological T stage (aOR = 5.58; 95% CI: 1.95-9.20), higher prostate-specific antigen level (aOR = 1.05 per ng/ml; 95% CI: 1.01-1.09), and higher pathological Gleason score. Larger prostate weight and volume were protective. Associations with biopsy Gleason score, body mass index, nerve-sparing status, and age were inconsistent.Conclusions
Tumour aggressiveness, reflected by pathological stage, capsular invasion, and Gleason score, is the strongest determinant of PSM after RALRP, while larger prostate weight is protective. Integrating cohort and meta-analytic findings provides a comprehensive synthesis of factors associated with surgical margin status that may inform future risk stratification and surgical planning.
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BibTeX
@article{deb2026predictors,
title = {{Predictors of positive surgical margins after robot-assisted radical prostatectomy. A prospective cohort study and a systematic review with meta-analysis.}},
author = {Abdalla Ali Deb and Naufal Naushad and Stavros Moschonas and Hosam Serag and Ankur Mukherjee and Kareem Taha and Sami A Abbas and Abdellatif Mohamed Zayed and Ashraf M Shahin},
journal = {Central European journal of urology},
year = {2026},
month = jul,
doi = {10.5173/ceju.2025.0189},
url = {https://europepmc.org/article/MED/42903622},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Predictors of positive surgical margins after robot-assisted radical prostatectomy. A prospective cohort study and a systematic review with meta-analysis.
AU - Abdalla Ali Deb
AU - Naufal Naushad
AU - Stavros Moschonas
AU - Hosam Serag
AU - Ankur Mukherjee
AU - Kareem Taha
AU - Sami A Abbas
AU - Abdellatif Mohamed Zayed
AU - Ashraf M Shahin
PY - 2026
DA - 2026/07/07
JO - Central European journal of urology
DO - 10.5173/ceju.2025.0189
UR - https://europepmc.org/article/MED/42903622
AB - Introduction Positive surgical margins (PSMs) after robot-assisted laparoscopic radical prostatectomy (RALRP) are linked to increased biochemical recurrence risk, but predictors remain inconsistent. This study aimed to identify predictors of PSM through a prospective cohort analysis and a systematic review with meta-analysis.Material and methods We analyzed 100 consecutive patients undergoing RALRP at a tertiary centre (2016-2018). Logistic regression assessed associations between clinical, pathological, and surgical variables and PSM. Cox regression evaluated the impact of PSM on biochemical recurrence. In parallel, a meta-analysis of studies reporting regression-based predictors of PSM after RALRP was conducted. Random-effects models pooled adjusted and unadjusted odds ratios.Results In the cohort, 22% of patients had PSM, most frequently at the apex. Lower prostate weight was the only independent predictor of PSM (OR = 0.964 per gram; 95% CI: 0.95-0.98). PSM independently predicted biochemical recurrence (HR = 5.29; 95% CI: 1.38-20.19). The meta-analysis of 13 studies confirmed significant associations between PSM and higher pathological T stage (aOR = 5.58; 95% CI: 1.95-9.20), higher prostate-specific antigen level (aOR = 1.05 per ng/ml; 95% CI: 1.01-1.09), and higher pathological Gleason score. Larger prostate weight and volume were protective. Associations with biopsy Gleason score, body mass index, nerve-sparing status, and age were inconsistent.Conclusions Tumour aggressiveness, reflected by pathological stage, capsular invasion, and Gleason score, is the strongest determinant of PSM after RALRP, while larger prostate weight is protective. Integrating cohort and meta-analytic findings provides a comprehensive synthesis of factors associated with surgical margin status that may inform future risk stratification and surgical planning.
SN - 2080-4806
SN - 2080-4873
ER -