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Yang CW, Wang HH, Fayez Hassouna M, Chand M, Huang WJ, Chung HJ. Effects of nerve-sparing procedures on surgical margins after robot-assisted radical prostatectomy. J Chin Med Assoc 2022; 85:1131-1135. [PMID: 36083634 DOI: 10.1097/jcma.0000000000000810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Nerve-sparing (NS) techniques could potentially increase positive surgical margins after robot-assisted radical prostatectomy (RARP). Nevertheless, the available studies have revealed ambiguous results among distinct groups. This study purposed to clarify the details of NS techniques to accurately estimate their influence on margin status. METHODS We studied RARPs performed by one surgeon from 2010 to 2018. Surgical margins were evaluated by the laterality and levels of NS techniques in site-specific prostate lobes. The multivariable analysis evaluated the effects of nerve-sparing procedures, combined with other covariate factors, on margin status. RESULTS Overall, 419 RARPs involving 838 prostate lobes were analyzed. Notably, 181 patients (43.4%) had pT2-stage, and 236 (56.6%) had pT3-stage cancer. The PSM rates for patients who underwent unilateral, bilateral, and non NS procedures were 30.3%, 28.8%, and 50%, respectively ( p = 0.233) or in stratification by pT2 ( p = 0.584) and pT3 ( p = 0.116) stage. The posterolateral PSM rates among site-specific prostate lobes were 10.9%, 22.4%, and 18.9% for complete, partial, and non NS techniques, respectively ( p = 0.001). The partial NS group revealed a significant increase in PSM rate compared with the complete NS (OR 2.187, 95% CI: 1.19-4.03) and non NS (OR 2.237, 95% CI: 1.01-4.93) groups in site-specific prostate lobes. CONCLUSION Partial NS procedures have a potential risk of increasing the positive surgical margins rate than complete and non NS procedures do. Therefore, correct case selection is required before performing partial NS techniques.
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Affiliation(s)
- Ching-Wei Yang
- Department of Urology, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei Taiwan, ROC
- Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Wellcome EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom
| | - Hsiao-Hsien Wang
- Department of Urology, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
| | - Mohamed Fayez Hassouna
- Wellcome EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom
| | - Manish Chand
- Wellcome EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom
- Department of Colorectal Surgery, University College London Hospital, London, United Kingdom
| | - William J Huang
- Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hsiao-Jen Chung
- Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Kyriazis I, Spinos T, Tsaturyan A, Kallidonis P, Stolzenburg JU, Liatsikos E. Different Nerve-Sparing Techniques during Radical Prostatectomy and Their Impact on Functional Outcomes. Cancers (Basel) 2022; 14:cancers14071601. [PMID: 35406373 PMCID: PMC8996922 DOI: 10.3390/cancers14071601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Optimum preservation of potency and continence after radical prostatectomy (RP) are equally important surgical endpoints as cancer control itself. Nerve-sparing technique during RP has a major impact to both oncological and functional outcomes of the procedure and various different techniques have been developed aiming to optimize its outcomes. This literature review aims to summarize all different nerve-sparing techniques applied during RP from its first description from Patrick C. Walsh to its newer trends. The review underlines that optimum nerve-sparing expands far beyond recognising and preserving the anatomical integrity of the neurovascular bundles. It also emphasises that nerve-sparing is a field under constant development, with new technologies entering continuously the nerve-sparing field corresponding to the evolving open, laparoscopic and robotic-assisted RP approaches. Abstract The purpose of this narrative review is to describe the different nerve-sparing techniques applied during radical prostatectomy and document their functional impact on postoperative outcomes. We performed a PubMed search of the literature using the keywords “nerve-sparing”, “techniques”, “prostatectomy” and “outcomes”. Other potentially eligible studies were retrieved using the reference list of the included studies. Nerve-sparing techniques can be distinguished based on the fascial planes of dissection (intrafascial, interfascial or extrafascial), the direction of dissection (retrograde or antegrade), the timing of the neurovascular bundle dissection off the prostate (early vs. late release), the use of cautery, the application of traction and the number of the neurovascular bundles which are preserved. Despite this rough categorisation, many techniques have been developed which cannot be integrated in one of the categories described above. Moreover, emerging technologies have entered the nerve-sparing field, making its future even more promising. Bilateral nerve-sparing of maximal extent, athermal dissection of the neurovascular bundles with avoidance of traction and utilization of the correct planes remain the basic principles for achieving optimum functional outcomes. Given that potency and continence outcomes after radical prostatectomy are multifactorial endpoints in addition to the difficulty in their postoperative assessment and the well-documented discrepancy existing in their definition, safe conclusions about the superiority of one technique over the other cannot be easily drawn. Further studies, comparing the different nerve-sparing techniques, are necessary.
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Affiliation(s)
- Iason Kyriazis
- Department of Urology, University of Patras, 26504 Patras, Greece; (I.K.); (T.S.); (A.T.); (P.K.)
| | - Theodoros Spinos
- Department of Urology, University of Patras, 26504 Patras, Greece; (I.K.); (T.S.); (A.T.); (P.K.)
| | - Arman Tsaturyan
- Department of Urology, University of Patras, 26504 Patras, Greece; (I.K.); (T.S.); (A.T.); (P.K.)
| | - Panagiotis Kallidonis
- Department of Urology, University of Patras, 26504 Patras, Greece; (I.K.); (T.S.); (A.T.); (P.K.)
| | | | - Evangelos Liatsikos
- Department of Urology, University of Patras, 26504 Patras, Greece; (I.K.); (T.S.); (A.T.); (P.K.)
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, 119435 Moscow, Russia
- Correspondence: ; Tel.: +30-2610-999-386
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Wang X, Guo J, Wang L, Wang M, Weng X, Chen H, Liu X. Modified completely intrafascial radical cysprostatectomy for bladder cancer: a single-center, blinded, controlled study. BMC Cancer 2021; 21:887. [PMID: 34340675 PMCID: PMC8330068 DOI: 10.1186/s12885-021-08568-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We have proposed a modified, completely intrafascial radical cysprostatectomy (RC) to treat bladder cancer patients with the aim of preserving the patients' post-surgical urinary control and erectile function. This study aimed to evaluate the oncological and functional outcomes of this innovation relatively to that with the conventional technique. METHODS A retrospective, single-center, blinded, and controlled study was conducted using the medical data of patients since the past 5 years from the hospital database. A total of 44 patients were included, including 20 who received complete intrafascial cysprostatectomy and 24 who received conventional interfascial surgeries. The patients' continent and sexual information of 1-year follow-up after the surgery were extracted. The oncological and functional outcomes of the 2 groups were compared and analyzed. RESULTS The demographics parameters of the 2 groups showed no significant difference. The results of follow-up of the oncological outcomes did not reveal any significant difference between the completely intrafascial group and the conventional interfascial group in terms of the positive surgical margins, local recurrences, and distant metastasis. Patients following neobladder diversion in the intrafascial group showed a faster recovery of the urinary control, with a 76.9% (10/13) daytime continent rate at 3-month, as well as 46.2% (6/13) and 58.3% (7/12) nighttime continent rates at 3-month and 6-month, respectively. Regarding the sexual functions, our results revealed significant advantages in favor of completely intrafascial technique on the post-surgical International Index of Erectile Function (IIEF)-5 score at 3-, 9-, and 12-month follow-up relative to that with the conventional interfascial process. Thus, the IIEF score of patients in the intrafascial group was 11.4 ± 3.5 at 3-month, 14.1 ± 3.6 at 9-month, and 15.2 ± 3.8 at 12-month follow-up after the cystectomy, which was significantly greater than that of the patients in the control group. CONCLUSIONS Our novel data illustrated that the modified completely intrafascial technique could result in a better sexual function and faster continence recovery for patients following RC, without any compromise in the cancer control. Thus, this technique could be considered as an alternative extirpative technique for bladder cancer treatment in a clinical setting.
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Affiliation(s)
- Xiao Wang
- Department of Urology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, P.R. China
| | - Jia Guo
- Department of Urology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, P.R. China
| | - Lei Wang
- Department of Urology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, P.R. China
| | - Min Wang
- Department of Urology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, P.R. China
| | - Xiaodong Weng
- Department of Urology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, P.R. China
| | - Hui Chen
- Department of Urology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, P.R. China
| | - Xiuheng Liu
- Department of Urology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, P.R. China.
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Asimakopoulos AD, Annino F, Mugnier C, Lopez L, Hoepffner JL, Gaston R, Piechaud T. Robotic radical prostatectomy: analysis of midterm pathologic and oncologic outcomes: A historical series from a high-volume center. Surg Endosc 2020; 35:6731-6745. [PMID: 33289056 PMCID: PMC8599245 DOI: 10.1007/s00464-020-08177-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/15/2020] [Indexed: 11/12/2022]
Abstract
Background Identifying predictors of positive surgical margins (PSM) and biochemical recurrence (BCR) after radical prostatectomy (RP) may assist clinicians in formulating prognosis. Aim of the study was to report the midterm oncologic outcomes, to identify the risk factors for PSM and BCR and assess the impact of the PSM on BCR-free survival following robot-assisted laparoscopic radical prostatectomy (RALP). Methods From 2005 to 2010, 1679 consecutive patients underwent transperitoneal RALP. Data was retrospectively collected by an independent statistical company and analyzed in 2014. Median postoperative follow-up was 33.5 mo. BCR was defined as any detectable serum prostate-specific antigen (PSA) ≥ 0.2 ng/mL in two consecutive measurements. BCR-free survival was estimated using the Kaplan–Meier method. Univariate and multivariate analysis were applied to identify risk factors for PSM and BCR. Results In pN0/pNx cancers, pathologic stage was pT2 in 1186 patients (71.8%), pT3 in 455 patients (27.6%), and pT4 in 11 patients (0.6%). PSM rate was 17.4% and 36.9% of pT2 and pT3 cancers, respectively. Pathologic Gleason score was < 7, = 7 and > 7 in 42.1%, 53% and 4.9% of the patients, respectively. Overall BCR-free survival was 73.1% at 5 years; the 5-year BCR-free survival was 87.9% for pT2 with negative surgical margins. PSA, Gleason score (both bioptic and pathologic), pathologic stage (pT) and surgeon's volume were significant independent predictors of PSM. PSA, pathologic Gleason score, pT and PSM were significant independent predictors of BCR-free survival. Seminal vesicle-sparing, nerve-sparing approach and the extent of nerve-sparing (intra vs interfascial dissection) did not negatively affect margin status or BCR rates. Conclusions PSMs are a predictor of BCR. Being the only modifiable factor influencing the PSM rate, surgical experience is confirmed as a key factor for high-quality oncologic outcomes.
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Affiliation(s)
- Anastasios D Asimakopoulos
- Department of Urology, Clinique Saint Augustin, Bordeaux, France. .,Department of Surgical Sciences, Unit of Urology, Fondazione PTV Policlinico Tor Vergata, Rome, Italy.
| | - Filippo Annino
- Department of Urology, Clinique Saint Augustin, Bordeaux, France.,Unit of Urology, Ospedale San Donato, Arezzo, Italy
| | - Camille Mugnier
- Department of Urology, Clinique Saint Augustin, Bordeaux, France
| | - Laurent Lopez
- Department of Urology, Clinique Saint Augustin, Bordeaux, France
| | | | - Richard Gaston
- Department of Urology, Clinique Saint Augustin, Bordeaux, France
| | - Thierry Piechaud
- Department of Urology, Clinique Saint Augustin, Bordeaux, France
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