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The neurovascular structure-adjacent frozen-section examination (NeuroSAFE) approach to nerve sparing in robot-assisted laparoscopic radical prostatectomy in a British setting - a prospective observational comparative study.
BJU Int. 2018 06; 121(6):854-862.BI

Abstract

OBJECTIVES

To evaluate the neurovascular structure-adjacent frozen-section examination (NeuroSAFE) 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 NeuroSAFE approach and those who had NS without NeuroSAFE. We also compared all the RALPs before and after the introduction of NeuroSAFE. Statistical analysis was done using the two-tailed t-test and chi-squared analysis.

RESULTS

This single surgeon series included 417 RALPs, including 120 NeuroSAFEs. The NeuroSAFE 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-NeuroSAFE NS cohort. After the introduction of NeuroSAFE, more preoperatively potent men underwent bilateral NS with pT2 disease (84.6% vs 66.3%, P = 0.002) and more overall NS were performed in patients with pT3 disease (65.1% vs 36.7%, P = 0.012). Overall positive surgical margin (PSM) rates were lower in the NeuroSAFE cohort compared to those who had NS without NeuroSAFE (9.2% vs 17.8%, P = 0.04). The 12-month potency rates were also higher in the NeuroSAFE 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 NeuroSAFE 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 NeuroSAFE allowed us to offer NS in higher risk patients, whilst reducing PSM rates and at the same time improving potency at 12 months.

Authors+Show Affiliations

Hertfordshire and Bedfordshire Urological Cancer Centre at the Lister Hospital, Stevenage, Hertfordshire, UK.Hertfordshire and Bedfordshire Urological Cancer Centre at the Lister Hospital, Stevenage, Hertfordshire, UK.Hertfordshire and Bedfordshire Urological Cancer Centre at the Lister Hospital, Stevenage, Hertfordshire, UK.Hertfordshire and Bedfordshire Urological Cancer Centre at the Lister Hospital, Stevenage, Hertfordshire, UK.Hertfordshire and Bedfordshire Urological Cancer Centre at the Lister Hospital, Stevenage, Hertfordshire, UK.Hertfordshire and Bedfordshire Urological Cancer Centre at the Lister Hospital, Stevenage, Hertfordshire, UK.Hertfordshire and Bedfordshire Urological Cancer Centre at the Lister Hospital, Stevenage, Hertfordshire, UK.Hertfordshire and Bedfordshire Urological Cancer Centre at the Lister Hospital, Stevenage, Hertfordshire, UK.Hertfordshire and Bedfordshire Urological Cancer Centre at the Lister Hospital, Stevenage, Hertfordshire, UK.

Pub Type(s)

Comparative Study
Journal Article
Observational Study

Language

eng

PubMed ID

29124889

Citation

Mirmilstein, George, et al. "The Neurovascular Structure-adjacent Frozen-section Examination (NeuroSAFE) Approach to Nerve Sparing in Robot-assisted Laparoscopic Radical Prostatectomy in a British Setting - a Prospective Observational Comparative Study." BJU International, vol. 121, no. 6, 2018, pp. 854-862.
Mirmilstein G, Rai BP, Gbolahan O, et al. The neurovascular structure-adjacent frozen-section examination (NeuroSAFE) approach to nerve sparing in robot-assisted laparoscopic radical prostatectomy in a British setting - a prospective observational comparative study. BJU Int. 2018;121(6):854-862.
Mirmilstein, G., Rai, B. P., Gbolahan, O., Srirangam, V., Narula, A., Agarwal, S., Lane, T. M., Vasdev, N., & Adshead, J. (2018). The neurovascular structure-adjacent frozen-section examination (NeuroSAFE) approach to nerve sparing in robot-assisted laparoscopic radical prostatectomy in a British setting - a prospective observational comparative study. BJU International, 121(6), 854-862. https://doi.org/10.1111/bju.14078
Mirmilstein G, et al. The Neurovascular Structure-adjacent Frozen-section Examination (NeuroSAFE) Approach to Nerve Sparing in Robot-assisted Laparoscopic Radical Prostatectomy in a British Setting - a Prospective Observational Comparative Study. BJU Int. 2018;121(6):854-862. PubMed PMID: 29124889.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The neurovascular structure-adjacent frozen-section examination (NeuroSAFE) approach to nerve sparing in robot-assisted laparoscopic radical prostatectomy in a British setting - a prospective observational comparative study. AU - Mirmilstein,George, AU - Rai,Bhavan Prasad, AU - Gbolahan,Olayinka, AU - Srirangam,Vinaya, AU - Narula,Ashish, AU - Agarwal,Samita, AU - Lane,Tim M, AU - Vasdev,Nikhil, AU - Adshead,James, Y1 - 2017/11/30/ PY - 2017/11/11/pubmed PY - 2019/1/29/medline PY - 2017/11/11/entrez KW - NeuroSAFE KW - frozen section KW - nerve sparing KW - potency KW - prostate cancer KW - prostatectomy SP - 854 EP - 862 JF - BJU international JO - BJU Int. VL - 121 IS - 6 N2 - OBJECTIVES: To evaluate the neurovascular structure-adjacent frozen-section examination (NeuroSAFE) 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 NeuroSAFE approach and those who had NS without NeuroSAFE. We also compared all the RALPs before and after the introduction of NeuroSAFE. Statistical analysis was done using the two-tailed t-test and chi-squared analysis. RESULTS: This single surgeon series included 417 RALPs, including 120 NeuroSAFEs. The NeuroSAFE 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-NeuroSAFE NS cohort. After the introduction of NeuroSAFE, more preoperatively potent men underwent bilateral NS with pT2 disease (84.6% vs 66.3%, P = 0.002) and more overall NS were performed in patients with pT3 disease (65.1% vs 36.7%, P = 0.012). Overall positive surgical margin (PSM) rates were lower in the NeuroSAFE cohort compared to those who had NS without NeuroSAFE (9.2% vs 17.8%, P = 0.04). The 12-month potency rates were also higher in the NeuroSAFE 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 NeuroSAFE 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 NeuroSAFE allowed us to offer NS in higher risk patients, whilst reducing PSM rates and at the same time improving potency at 12 months. SN - 1464-410X UR - https://www.unboundmedicine.com/medline/citation/29124889/The_neurovascular_structure_adjacent_frozen_section_examination__NeuroSAFE__approach_to_nerve_sparing_in_robot_assisted_laparoscopic_radical_prostatectomy_in_a_British_setting___a_prospective_observational_comparative_study_ L2 - https://doi.org/10.1111/bju.14078 DB - PRIME DP - Unbound Medicine ER -