PD27-03 NERVE-SPARING RADICAL PROSTATECTOMY (NSRP) USING THE NEUROSAFE TECHNIQUE IS ONCOLOGICALLY SAFE: RESULTS AFTER 20 YEARS OF EXPERIENCE

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD27-03 NERVE-SPARING RADICAL PROSTATECTOMY (NSRP) USING THE NEUROSAFE TECHNIQUE IS ONCOLOGICALLY SAFE: RESULTS AFTER 20 YEARS OF EXPERIENCE Francesca Ambrosini, Randi M. Pose, Derya Tilki, Felix K. H. Chun, Thomas Steuber, Georg Salomon, Uwe Michl, Hans Heinzer, Tobias Maurer, Hendrik Isbarn, Lars Budäus, Hartwig Huland, Carlo Terrone, Pierre Tennstedt, Markus Graefen, and Alexander Haese Francesca AmbrosiniFrancesca Ambrosini More articles by this author , Randi M. PoseRandi M. Pose More articles by this author , Derya TilkiDerya Tilki More articles by this author , Felix K. H. ChunFelix K. H. Chun More articles by this author , Thomas SteuberThomas Steuber More articles by this author , Georg SalomonGeorg Salomon More articles by this author , Uwe MichlUwe Michl More articles by this author , Hans HeinzerHans Heinzer More articles by this author , Tobias MaurerTobias Maurer More articles by this author , Hendrik IsbarnHendrik Isbarn More articles by this author , Lars BudäusLars Budäus More articles by this author , Hartwig HulandHartwig Huland More articles by this author , Carlo TerroneCarlo Terrone More articles by this author , Pierre TennstedtPierre Tennstedt More articles by this author , Markus GraefenMarkus Graefen More articles by this author , and Alexander HaeseAlexander Haese More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003305.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: It has been established in either retrospective comparative studies or randomized controlled trials that the neurovascular structure-adjacent frozen-section examination (NeuroSAFE) during NSRP significantly increases the nerve-sparing procedures (NS) and reduces the positive surgical margins (PSMs), but the long-term oncological outcomes have not yet been evaluated. METHODS: We analyzed long-term follow-up data prospectively collected into our institutional review board-approved database of consecutive open retropubic and robot-assisted radical prostatectomies (RPs) performed between January 2002 to June 2011. In the NeuroSAFE technique, the complete neurovascular structures adjacent to prostatic margins are removed and the specimen is stained for proper cryo-sectioning and anatomic alignment. Baseline characteristics between NeuroSAFE and non-NeuroSAFE patients were compared using the chi-square likelihood test. The impact of NeuroSAFE on biochemical recurrence-free survival (BFS) was analyzed by log-rank test, and Kaplan-Meier analysis in propensity score (PS)–based matched cohorts. PS-matching was performed 1:1 using PSA, pT stage, Gleason score (GS), and pN-status as covariates. RESULTS: From January 2002 to June 2011, 11069 consecutive RPs were collected. Of these, 5392 (49%) were performed with NeuroSAFE. Long-term oncological outcomes were assessed in an adjusted cohort of 2567 matched pairs. In NeuroSAFE vs the matched non-NeuroSAFE RPs, frequency of NS was significantly higher (all stages: 97% vs 81%; pT2: 99% vs 92%; pT3a: 94% vs 72%; pT3b: 88% vs 40%; p<0.0001) and PSM rates were significantly lower (all stages: 15% vs 22%; pT2: 7% vs 12%; pT3a: 21% vs 32%; p<0.0001). After a median follow-up of 132 (interquartile range 81.8 - 158) months, 10-yr BFS in NeuroSAFE pts didn’t differ from non-NeuroSAFE pts (5-yr- and 10-yr-BFS: pT2: 88.5 % vs 88.6%; 79.9% vs 81.4%, p=0.35; pT3a: 65.8% vs 67.2%; 53.3% vs 55.3%, p=0.58; ≥pT3b: 35.7% vs 34.5%; 20.3% vs 23.9%, p=0.95) (Figure 1). CONCLUSIONS: Even after 10 years of follow-up, NeuroSAFE has no negative impact on BFS, and it can be considered a safe option to improve the NS procedure without unfavorable effects on the oncological outcomes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e742 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Francesca Ambrosini More articles by this author Randi M. Pose More articles by this author Derya Tilki More articles by this author Felix K. H. Chun More articles by this author Thomas Steuber More articles by this author Georg Salomon More articles by this author Uwe Michl More articles by this author Hans Heinzer More articles by this author Tobias Maurer More articles by this author Hendrik Isbarn More articles by this author Lars Budäus More articles by this author Hartwig Huland More articles by this author Carlo Terrone More articles by this author Pierre Tennstedt More articles by this author Markus Graefen More articles by this author Alexander Haese More articles by this author Expand All Advertisement PDF downloadLoading ...