Netherland: Nerve-sparing may increase the risk of ipsilateral positive surgical margins, finds a recent study in the Journal of Urology. This increased risk should be considered in counseling patients who opt for nerve-sparing robot-assisted radical prostatectomy.
Published studies that have evaluated the association between nerve sparing robot-assisted radical prostatectomy and ipsilateral positive surgical margins risk were subjected to selection bias. T. F. W. Soeterik, Department of Value-Based Healthcare, Santeon, Utrecht, The Netherlands, and colleagues however claim that in this study they have overcome these limitations through the use of multivariable regression analysis.
The study included 2,574 patients who were undergoing robot-assisted radical prostatectomy for prostate cancer at 4 institutions from 2013 to 2018. 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. A total of 5,148 prostate lobes were derived from these patients.
Key findings of the study include:
Multivariable analysis showed nerve sparing was an independent predictor for ipsilateral positive margins (OR 1.42).
Other significant predictors for positive margins were prostate specific antigen density (OR 3.64) and side specific covariates including highest preoperative ISUP (International Society of Urological Pathology) biopsy grade (OR 1.58, OR 1.62, OR 2.11, and OR 4.43 for ISUP grade 2, 3, 4 and 5, respectively), presence of extraprostatic extension on magnetic resonance imaging (OR 1.42) and percentage of positive cores on systematic biopsy (OR 3.82).
"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," concluded the authors.
The study, "Nerve Sparing during Robot-Assisted Radical Prostatectomy Increases the Risk of Ipsilateral Positive Surgical Margins," is published in the Journal of Urology.
DOI: https://doi.org/10.1097/JU.0000000000000760