Impact of positive surgical margin location after radical prostatectomy: a network meta-analysis.

Abstract

Objective: To perform a network meta-analysis comparing the impact of different positive surgical margin locations (Comparisons and intervention) on biochemical recurrence (Outcome) in patients undergoing radical prostatectomy (Population).

Methods: According to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, a protocol was registered (PROSPERO: CRD42022119025) and a search across four databases was conducted (the MEDLINE, Scopus, Embase and Cochrane). The primary outcome was biochemical recurrence (BCR). A network meta-analysis was conducted. Further subgroup analysis was performed to evaluate studies exploring robot-assisted radical prostatectomy (RALP).

Results: Our search yielded 1249 unique results; 22 studies were analysed. Anterior margins had the highest risk of BCR (HR 2.46, 95%CI 1.67-3.61, I² = 76%) followed by posterior (HR 2.29, 95%CI 1.43-3.66, I² = 0%), bladder base (HR 2.06, 95%CI 1.61-2.64, I² = 69%), apical (HR 1.88, 95%CI 1.51-2.35, I² = 59%), and posterolateral margins (HR 1.70, 95%CI 1.14-2.25, I² = 60%). Given significant heterogeneity, subgroup analysis was performed. In the RALP subgroup, anterior margins also demonstrated the highest recurrence risk (HR 3.74, 95%CI 2.47-5.66, I² = 0%), followed by apical (HR 2.43, 95%CI 1.97-8.00, I² = 0%), posterior (HR 2.23, 95%CI 1.47-3.38), base (HR 1.65, 95%CI 1.29-2.11, I² = 0%), and posterolateral margin (HR 1.54, 95%CI 1.07-2.22).

Conclusions: The risk of BCR after radical prostatectomy varies by PSM location, with the highest recurrence risk observed at anterior margins.