Evidence map›Paper›PMID 42803970›Full record

ArticleWorld journal of urology2026

Aetiology of positive surgical margins in robotic assisted radical prostatectomy: a pathway approach.

Elizabeth Day, Andreia Bilé-Silva, Amit Bhudia, Abhishek Vigneshkumar, Georgi Petkov, Keiron Hakimnia, Farah Siddiqui, Aiman Haider, Louise Dickinson, Zafer Tandogdu

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Article in World journal of urology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

10 authors.

Elizabeth DayUniversity Hospital Ayr, Ayr, Scotland, UK.ORCID http://orcid.org/0000-0002-3773-3836
Andreia Bilé-SilvaDivision of Surgery and Interventional Science, University College London, London, UK.ORCID http://orcid.org/0000-0003-2429-2688
Amit BhudiaSchool of Medicine, University College London Hospital, London, UK.
Abhishek VigneshkumarSchool of Medicine, University College London Hospital, London, UK.
Georgi PetkovSchool of Medicine, University College London Hospital, London, UK.
Keiron HakimniaSchool of Medicine, University College London Hospital, London, UK.
Farah SiddiquiSchool of Medicine, University College London Hospital, London, UK.
Aiman HaiderDepartment of Pathology, University College London Hospitals, London, UK.ORCID http://orcid.org/0000-0002-7005-4245
Louise DickinsonDivision of Surgery and Interventional Science, University College London, London, UK.ORCID http://orcid.org/0009-0009-5703-5742
Zafer TandogduDivision of Surgery and Interventional Science, University College London, London, UK. zafer.tandogdu@outlook.com.ORCID http://orcid.org/0000-0002-5309-3656

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposePositive surgical margin (PSM) rates in robot-assisted radical prostatectomy (RARP) remain high and understanding their cause remains key to their elimination. We examined the prostate cancer pathway as a whole to systematically identify and quantify sourcescontributing to PSMs.

methodsUsing a prospectively maintained database at a high-volume centre, we retrospectively analysed 100 consecutive patients with positive surgical margins (PSMs) following robot-assisted radical prostatectomy between January and December 2022. For each patient, a pre-operative imaging-based surgical plan was available. Potential sources contributing to PSMs were identified by reviewing diagnostic and staging information, the recommended surgical plan, the executed surgical template, and final pathology. Sources were categorised into three pathway phases: Diagnostic and Staging, Surgical Planning, and Surgical Execution. Proportions were reported with 95% confidence intervals calculated using the exact binomial (Clopper-Pearson) method.

resultsA total of 112 positive surgical margins (PSMs) were identified in 100 patients. One hundred and twenty-five contributing sources were identified, with a single source attributed to 102 PSMs, two sources to 7 PSMs, and three sources to 3 PSMs. Surgical execution accounted for the majority of identified sources (98/125, 78.4%; 95% CI 70.2-85.3%), followed by surgical planning (14/125, 11.2%; 95% CI 6.3-18.1%) and diagnostic and staging factors (13/125, 10.4%; 95% CI 5.7-17.1%). Within the surgical execution category, nerve-sparing was the most frequently implicated surgical step, being associated with 57/112 PSMs (50.9%; 95% CI 41.3-60.5%), followed by apical dissection (34/112, 30.4%; 95% CI 22.0-39.8%).

conclusionDespite high volume, the most common sourceis surgical execution. This represents an opportunity for intra-operative margin assessment to reduce PSM rates. Diagnostic and planning steps still contributed to one- fifth of PSMs and can also be improved. We emphasise how this novel systematic approach can be used as a framework in quality assurance and improvement processes.

Indexed as

Margins of ExcisionProstatectomyProstatic NeoplasmsRobotic Surgical ProceduresAgedHumansMaleMiddle AgedRetrospective StudiesMRIPositive surgical marginsProstate cancerRobotic assisted radical prostatectomySurgical planning

Identifiers

PMID42803970

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.