In:
BJU International, Wiley, Vol. 121, No. 6 ( 2018-06), p. 854-862
Abstract:
To evaluate the neurovascular structure‐adjacent frozen‐section examination (Neuro SAFE ) technique in a British setting in men undergoing robot‐assisted laparoscopic radical prostatectomy ( RALP ) . Patients and Methods We retrospectively analysed our prospectively maintained database of patients who underwent RALP between November 2008 and February 2017. We examined preoperative pathological and functional parameters, intraoperative nerve sparing ( NS ), postoperative histology, as well as functional and oncological follow‐up. We compared those who had a Neuro SAFE approach and those who had NS without Neuro SAFE . We also compared all the RALP s before and after the introduction of Neuro SAFE . Statistical analysis was done using the two‐tailed t ‐test and chi‐squared analysis. Results This single surgeon series included 417 RALP s, including 120 Neuro SAFE s. The Neuro SAFE cohort had a greater proportion of D'Amico high‐risk disease (30.8% vs 9.6%, P 〈 0.001), higher Gleason scores and higher pT stage compared to the non‐Neuro SAFE NS cohort. After the introduction of Neuro SAFE , more preoperatively potent men underwent bilateral NS with pT 2 disease (84.6% vs 66.3%, P = 0.002) and more overall NS were performed in patients with pT 3 disease (65.1% vs 36.7%, P = 0.012). Overall positive surgical margin ( PSM ) rates were lower in the Neuro SAFE cohort compared to those who had NS without Neuro SAFE (9.2% vs 17.8%, P = 0.04). The 12‐month potency rates were also higher in the Neuro SAFE cohort for both bilateral (77.3% vs 50.9%, P = 0.009) and unilateral (70.6% vs 40%, P = 0.04) NS . Pad‐free continence was also higher in the Neuro SAFE group (85.7% vs 70.9%, P = 0.019), but there was no significant difference between those who were wearing ≤1 safety pad. Although we only had short‐term oncological follow‐up, it did not significantly differ between the two groups. Conclusion Adoption of Neuro SAFE allowed us to offer NS in higher risk patients, whilst reducing PSM rates and at the same time improving potency at 12 months.
Type of Medium:
Online Resource
ISSN:
1464-4096
,
1464-410X
DOI:
10.1111/bju.2018.121.issue-6
Language:
English
Publisher:
Wiley
Publication Date:
2018
detail.hit.zdb_id:
2019983-1
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