DR  HAREWOOD
B.Sc.,MB.BS.,F.R.A.C.S
UROLOGIST
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ROBOT
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ASSOCIATE PROFESSOR HAREWOOD

SPECIALISING IN ROBOTIC RADICAL PROSTATECTOMY OR "DA VINCI PROSTATECTOMY"

Robot surgery

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RESULTS
Positive Margin Rates:

A major indicator of whether all the Cancer in the Prostate has been removed at surgery, is whether there is a positive margin or not in the specimen of the prostate, after it has been excised from the patient.

A positive margin is when there are cancer cells present at the cut margin of the prostate when it has been examined by the pathologist after the prostate has been removed.

crossection drawing of prostate with cancer inside
Cancer confined within the capsule of the prostate with a negative margin, i.e. the cancer has been completely removed.
crossection drawing of prostate with cancer, there is a slice through the middle of the cancer
Organ confined Cancer where the cancer has been cut through, causing a positive margin, i.e cancer has probably been left behind.

If the margins are negative, it strongly indicates that all the cancer is likely to have been removed. If the margin is positive, it may indicate that some cancer has been left behind.
The best quality surgery, and the best Robotic surgeons have the lowest positive margin rates in their cases, indicating a higher rate of cure of their patients.

Professor Harewood has one of the lowest positive margins rates of any surgeon in the world.
When the cancer is confined inside the capsule or rind of the prostate (pT2), the positive margin rate should be very low, ie around 2% of cases only. If however the cancer has penetrated through the capsule, and has already spread outside the prostate (pT3), the positive margin rate is higher. It is still possible however to get all the cancer out.

After over 800 procedures Associate Professor Harewood's positive margin rates are as follows:


Number of PatientsNumber with Negative Margins.Number with Positive Margins.Positive Margin RateNumber of Positives that are focal only.
Overall8948029210.3%
Organ Confined (pT2)560549112.0%All
Non Organ Confined (pT3)3342538124.3%


The following table compares the positive margin rates of a number of series of Open Radical Prostatectomy, Laparoscopic Radical Prostatectomy and Robotic Radical Prostatectomy.

SeriesMethod of Surgery
(number of patients)
Positive Margin Rate:
Harewood LM. (Melbourne Australia). Current series.Robotic
(894 patients)
Overall:
pT2:
pT3:
10.3%
2.0%
24.3%
Patel VR. (Florida USA)
(Patel VR et al. BJU Int 2007 99:1109-1112)
Robotic
(500 patients)
Overall:
pT2:
pT3:
9.4%
2.5%
31.0%
Scardino PT (USA)
(Swindle P et al. J Urol. 2005 Sep;174(3):903-7)
Open Surgery
(1389 patients)
Overall:
pT2:
pT3:
12.9%
6.8%
23.0%
Smith JA (USA)
Smith JA et al. J Urol 2007 Dec;178:(6):2385-9
Open Surgery
(509 patients)
Overall:
pT2:
pT3:
35.0%
24.1%
60.0%
Smith JA (USA)
Smith JA et al. J Urol 2007 Dec;178:(6):2385-9
Robotic
(1238 patients)
Overall:
pT2:
pT3:
15.0%
9.4%
50.0%
Guillonneau (USA)
Touljer K et al European Urology 52 (2007) 1090-1096
Laparoscopic
(629 patients)
Overall:
pT2:
pT3:
11.3%
8.2%
17.2%
Menon M USA)
(Menon M et al. European Urology 51 (2007) 648-658
Robotic
(2652 patients)
Overall:
pT2:
pT3:
13.0%
-
-
Murphy DG (Melbourne Australia)
Murphy DG, Crowe H, Kerger M, Peters JS, Costello AJ. Abs 123 BJU Int 2008 101 (Supp 1) : pg 37
Robotic
(400 patients)
Overall:
pT2:
pT3:
24.1%
13.9%
52.3%

Conclusion: Associate Professor Harewood achieves world's best practice, with a very low positive margin rate equivalent to the world's best reported figures.