Hertfordshire and Bedfordshire Urological Cancer Centre at the Lister Hospital, Stevenage, Hertfordshire, UK.
BJU Int. 2018 Jun;121(6):854-862. doi: 10.1111/bju.14078. Epub 2017 Nov 30.
To evaluate the neurovascular structure-adjacent frozen-section examination (NeuroSAFE) technique in a British setting in men undergoing robot-assisted laparoscopic radical prostatectomy (RALP) .
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.
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.
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.
评估神经血管毗邻冷冻切片检查（NeuroSAFE）技术在英国行机器人辅助腹腔镜根治性前列腺切除术（RALP）的男性中的应用。
我们回顾性分析了 2008 年 11 月至 2017 年 2 月期间行 RALP 的患者前瞻性维护的数据库。我们检查了术前病理和功能参数、术中神经保留（NS）、术后组织学以及功能和肿瘤学随访。我们比较了接受 NeuroSAFE 方法和未接受 NeuroSAFE 的 NS 患者。我们还比较了引入 NeuroSAFE 前后的所有 RALP。使用双尾 t 检验和卡方分析进行统计学分析。
该单外科医生系列包括 417 例 RALP，其中 120 例进行了 NeuroSAFE。NeuroSAFE 组中 D'Amico 高危疾病的比例更高（30.8%比 9.6%，P<0.001），Gleason 评分和 pT 分期更高，与未接受 NeuroSAFE 的 NS 组相比。引入 NeuroSAFE 后，更多术前功能正常的男性接受了双侧 NS 伴 pT2 疾病（84.6%比 66.3%，P=0.002），更多伴 pT3 疾病的患者接受了总体 NS（65.1%比 36.7%，P=0.012）。与未接受 NeuroSAFE 的 NS 相比，NeuroSAFE 组的总体阳性切缘（PSM）率更低（9.2%比 17.8%，P=0.04）。NeuroSAFE 组的双侧（77.3%比 50.9%，P=0.009）和单侧（70.6%比 40%，P=0.04）NS 的 12 个月勃起功能恢复率也更高。NeuroSAFE 组无尿垫控尿率也更高（85.7%比 70.9%，P=0.019），但穿≤1 个安全垫的两组之间无显著差异。尽管我们只有短期的肿瘤学随访，但两组之间没有显著差异。
采用 NeuroSAFE 使我们能够为高危患者提供 NS，同时降低 PSM 率，同时提高 12 个月时的勃起功能。
