1794 WHEN TO PERFORM BILATERAL INTRAFASCIAL NERVE-SPARING ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY. IDENTIFICATION OF THE IDEAL CANDIDATE BASED ON PRE-OPERATIVE INFORMATION

Abstract

You have accessJournal of UrologyProstate Cancer: Localized1 Apr 20111794 WHEN TO PERFORM BILATERAL INTRAFASCIAL NERVE-SPARING ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY. IDENTIFICATION OF THE IDEAL CANDIDATE BASED ON PRE-OPERATIVE INFORMATION Andrea Gallina, Nazareno Suardi, Nicolò Buffi, Giulio Gadda, Giovanni Lughezzani, Emanuele Scapaticci, Matteo Zanoni, Mattia Sangalli, Aldo Bocciardi, Alberto Briganti, Andrea Cestari, Patrizio Rigatti, Giorgio Guazzoni, and Francesco Montorsi Andrea GallinaAndrea Gallina Milan, Italy More articles by this author , Nazareno SuardiNazareno Suardi Milan, Italy More articles by this author , Nicolò BuffiNicolò Buffi Milan, Italy More articles by this author , Giulio GaddaGiulio Gadda Milan, Italy More articles by this author , Giovanni LughezzaniGiovanni Lughezzani Milan, Italy More articles by this author , Emanuele ScapaticciEmanuele Scapaticci Milan, Italy More articles by this author , Matteo ZanoniMatteo Zanoni Milan, Italy More articles by this author , Mattia SangalliMattia Sangalli Milan, Italy More articles by this author , Aldo BocciardiAldo Bocciardi Milan, Italy More articles by this author , Alberto BrigantiAlberto Briganti Milan, Italy More articles by this author , Andrea CestariAndrea Cestari Milan, Italy More articles by this author , Patrizio RigattiPatrizio Rigatti Milan, Italy More articles by this author , Giorgio GuazzoniGiorgio Guazzoni Milan, Italy More articles by this author , and Francesco MontorsiFrancesco Montorsi Milan, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2144AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients treated with a bilateral intrafascial nerve sparing robot-assisted laparoscopic radical prostatectomy (ifBNSRALP) have shown to achieve excellent functional results. However, concerns have been raised about the potential increase in the rate of adverse pathological findings. The aim of this study was to pre-operatively identify patients suitable for this selected approach. METHODS The study included 212 consecutive patients treated with ifBNSRALP between January 2007 and July 2010 at a single tertiary referral center. All patients had detailed pre-and post-operative clinical data including PSA, clinical stage, biopsy Gleason sum, percentage of positive cores, surgical margin (SM) status and pathological stage. Adverse pathological findings were defined as the presence of either positive (+) SM or extracapsular extension. Univariable and multivariable logistic regression models were performed to evaluate the association between pre-operative predictors, namely pre-operative PSA, biopsy Gleason sum, clinical stage and percentage of positive cores and the presence of adverse pathology at ifBNSRALP. RESULTS Mean age at surgery was 63.4 yrs (median 64 yrs). Mean PSA was 6.1 ng/ml (median: 5.3 ng/mL). Clinical stage was T1 in 139 (82.5%) and T2 in 76 (17.5%) patients. Biopsy Gleason sum was ≤6 in 192 (91%) and 7 in 19 (9%) patients. Mean percentage of positive cores was 28.4% (median 25%; range 5–100%). Presence of either SM or extra-capsular extension was found in 56 (26.5%) patients. At univariable analyses, only percentage of positive cores represented a predictor of adverse pathology (p=0.01). At multivariable analyses, percentage of positive cores maintained a significant association with adverse pathology (p=0.02 and p=0.047). Interestingly, patients with T1c prostate cancer, PSA<10 ng/ml, Gleason score<7 and <30% of positive cores had only 14.3% rate of adverse findings compared to 32.5% of the remaining patients (p=0.02). CONCLUSIONS Intrafascial nerve sparing robot-assisted laparoscopic radical prostatectomy is associated with a non-negligible rate of adverse pathological findings. Careful selection of patients candidate to this procedure is thus warranted. Patients with low risk disease and <30% positive cores might represent the best candidate for this highly selected surgical approach. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e721 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrea Gallina Milan, Italy More articles by this author Nazareno Suardi Milan, Italy More articles by this author Nicolò Buffi Milan, Italy More articles by this author Giulio Gadda Milan, Italy More articles by this author Giovanni Lughezzani Milan, Italy More articles by this author Emanuele Scapaticci Milan, Italy More articles by this author Matteo Zanoni Milan, Italy More articles by this author Mattia Sangalli Milan, Italy More articles by this author Aldo Bocciardi Milan, Italy More articles by this author Alberto Briganti Milan, Italy More articles by this author Andrea Cestari Milan, Italy More articles by this author Patrizio Rigatti Milan, Italy More articles by this author Giorgio Guazzoni Milan, Italy More articles by this author Francesco Montorsi Milan, Italy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...