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Predictors of positive surgical margins after robot-assisted radical prostatectomy. A prospective cohort study and a systematic review with meta-analysis

Lookup NU author(s): Dr Ankur Mukherjee

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This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0).

Abstract

© 2026, Polish Urological Association. All rights reserved. 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. Inte-grating 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.

Publication metadata

Author(s): Deb AA, Naushad N, Moschonas S, Serag H, Mukherjee A, Taha K, Abbas SA, Zayed AM, Shahin AM

Publication type: Article

Publication status: Published

Journal: Central European Journal of Urology

Year: 2026

Volume: 79

Issue: 3

Pages: 243-268

Online publication date: 07/07/2026

Acceptance date: 03/03/2026

Date deposited: 01/09/2026

ISSN (print): 2080-4806

ISSN (electronic): 2080-4873

Publisher: Polish Urological Association

URL: https://doi.org/10.5173/ceju.2025.0189

DOI: 10.5173/ceju.2025.0189

Data Access Statement: Supplementary materials are included with the article.

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