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Nerve Sparing during Robot-Assisted Radical Prostatectomy Increases the Risk of Ipsilateral Positive Surgical Margins.

机器人辅助根治性前列腺切除术中的神经保留增加了同侧阳性手术切缘的风险。

  • 影响因子:1.46
  • DOI:10.1097/JU.0000000000000760
  • 作者列表:"Soeterik TFW","van Melick HHE","Dijksman LM","Stomps S","Witjes JA","van Basten JPA
  • 发表时间:2020-07-01
Abstract

PURPOSE:Available published studies evaluating the association between nerve sparing robot-assisted radical prostatectomy and risk of ipsilateral positive surgical margins were subject to selection bias. In this study we overcome these limitations by using multivariable regression analysis. MATERIALS AND METHODS:Patients undergoing robot-assisted radical prostatectomy for prostate cancer at 4 institutions from 2013 to 2018 were included in the study. A multilevel logistic random intercept model, including covariates on patient level and side specific factors on prostate lobe level, was used to evaluate the association between nerve sparing and risk of ipsilateral positive margins. RESULTS:A total of 5,148 prostate lobes derived from 2,574 patients who underwent robot-assisted radical prostatectomy were analyzed. Multivariable analysis showed nerve sparing was an independent predictor for ipsilateral positive margins (OR 1.42, 95% CI 1.14-1.82). Other significant predictors for positive margins were prostate specific antigen density (OR 3.64, 95% CI 2.36-5.90) and side specific covariates including highest preoperative ISUP (International Society of Urological Pathology) biopsy grade (OR 1.58, 95% CI 1.13-2.53; OR 1.62, 95% CI 1.13-2.69; OR 2.11, 95% CI 1.39-3.59 and OR 4.43, 95% CI 3.17-10.12 for ISUP grade 2, 3, 4 and 5, respectively), presence of extraprostatic extension on magnetic resonance imaging (OR 1.42, 95% CI 1.03-1.91) and percentage of positive cores on systematic biopsy (OR 3.82, 95% CI 2.50-5.86). CONCLUSIONS:Nerve sparing was associated with an increased risk of ipsilateral positive surgical margins. The increased risk of positive margins should be considered when counseling patients who opt for nerve sparing robot-assisted radical prostatectomy.

摘要

目的: 现有已发表的评估保留神经的机器人辅助根治性前列腺切除术与同侧阳性手术切缘风险之间相关性的研究受到选择偏倚的影响。在这项研究中,我们通过使用多变量回归分析克服了这些限制。 材料和方法: 研究纳入2013年至2018年在4家机构接受机器人辅助前列腺癌根治术的患者。采用多水平logistic随机截距模型,包括患者水平的协变量和前列腺叶水平的侧面特定因素,评估神经保留与同侧阳性边缘风险之间的关联。 结果: 共分析了5,148例机器人辅助根治性前列腺切除术患者的2,574个前列腺叶。多变量分析显示,神经保留是同侧切缘阳性的独立预测因子 (OR 1.42,95% CI 1.14-1.82)。阳性切缘的其他重要预测因子是前列腺特异性抗原密度 (OR 3.64,95% CI 2.36-5.90) 和侧面特异性协变量,包括最高的术前ISUP (国际泌尿病理学会) 活检分级 (OR 1.58,95% CI 1.13-2.53; OR 1.62,95% CI 1.13-2.69; OR 2.11,95% CI 1.39-3.59和OR 4.43,95% CI 3.17-10.12分别为ISUP 2级、3级、4级和5级),在磁共振成像中存在前列腺外延伸 (OR 1.42,95% CI 1.03-1.91) 和系统活检中阳性核心的百分比 (OR 3.82,95% CI 2.50-5.86)。 结论: 保留神经与同侧阳性手术切缘的风险增加相关。在咨询选择保留神经的机器人辅助根治性前列腺切除术的患者时,应考虑阳性切缘的风险增加。

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影响因子:2.56
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DOI:10.1007/s00345-019-02780-0
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METHODS:PURPOSE:To investigate whether hexaminolevulinate-based (HAL) bladder tumor resection (TURBT) impacts on outcomes of patients with primary non-muscle-invasive bladder cancer (NMIBC) who were eventually treated with radical cystectomy (RC). METHODS:A total of 131 consecutive patients exhibiting NMIBC at primary diagnosis were retrospectively investigated whether they had undergone any HAL-guided TURBT prior to RC. Uni- and multivariable analyses were used to evaluate the impact of HAL-TURBT on cancer-specific (CSS) and overall survival (OS). The median follow-up was 38 months (IQR 13-56). RESULTS:Of the 131 patients, 69 (52.7%) were managed with HAL- and 62 (47.3%) with white light (WL)-TURBT only prior to RC. HAL-TURBT was associated with a higher number of TURBTs prior to RC (p = 0.002) and administration of intravesical chemotherapy (p = 0.043). A trend towards a higher rate of tumor-associated immune cell infiltrates in RC specimens (p = 0.07) and a lower utilization rate of post-operative systemic chemotherapy (p = 0.10) was noted for patients who were treated with HAL-TURBT. The 5-year CSS/OS was 90.9%/74.5% for the HAL-group and 73.8%/55.8% for the WL-group (p = 0.042/0.038). In multivariable analysis, lymph node tumor involvement (p = 0.007), positive surgical margins (p = 0.001) and performance of WL-TURBT only (p = 0.040) were independent predictors for cancer-specific death. CONCLUSIONS:The present data suggest that the resection of NMIBC under HAL exerts a beneficial impact on outcomes of patients who will need to undergo RC during their course of disease. This finding may be due to improved risk stratification as the resection under HAL may allow more patients to be treated timely and adequately.

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来源期刊:The Journal of urology
DOI:10.1097/JU.0000000000000313
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泌尿外科手术方向

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