Axén Elin, Godtman Rebecka Arnsrud, Bjartell Anders, Carlsson Stefan, Haglind Eva, Hugosson Jonas, Lantz Anna, Månsson Marianne, Steineck Gunnar, Wiklund Peter, Stranne Johan
Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Urology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.
Eur Urol Open Sci. 2021 Jun 19;30:25-33. doi: 10.1016/j.euros.2021.06.005. eCollection 2021 Aug.
Reports on possible benefits for continence with nerve-sparing (NS) radical prostatectomy have expanded the indications beyond preservation of erectile function. It is unclear whether NS surgery affects oncological outcomes.
To determine whether the degree of NS during radical prostatectomy influences oncological outcomes.
Of 4003 patients enrolled in a prospective, controlled trial comparing open and robotic radical prostatectomy during 2008-2011, we evaluated 2401 patients who received robotic radical prostatectomy at seven Swedish centres. Patients were followed for 8 yr.
Data for recurrence and positive surgical margin status were assessed using validated patient questionnaires, patient interviews, and clinical record forms before and at 3, 12, and 24 mo and 6 and 8 yr after surgery. Cox and logistic regressions were used to model the effect on recurrence and positive surgical margins (PSM), respectively.
A total of 481 men had PSM and 467 experienced recurrence during follow-up. Median follow-up for men without recurrence was 6.6 yr. There were no statistically significant differences in recurrence rate between degrees of NS. The PSM rate was significantly higher with a higher degree of NS: interfascial NS, odds ratio (OR) 2.32 (95% confidence interval [CI] 1.69-3.16); intrafascial NS, OR 3.23 (95% CI 2.17-4.80). Recurrence rates were higher for patients with pT2 disease and PSM (hazard ratio [HR] 3.32, 95% CI 2.43-4.53) than for patients with pT3 disease without PSM (HR 2.08, 95% CI 1.66-2.62). The lack of central review of pathological specimens is a limitation.
A higher degree of NS significantly increased the risk of PSM but did not significantly increase the risk of cancer recurrence. Combined with the known functional benefits of NS surgery, these results underscore the need to identify an individualised balance.
In this report we looked at the effect of a nerve-sparing approach during removal of the prostate on cancer outcomes for patients having robot-assisted surgery at seven Swedish hospitals. We found that a high degree of nerve-sparing increased the rate of cancer positivity at the margins of surgical specimens and that positive surgical margins increased the risk of recurrence of prostate cancer.
关于保留神经（NS）的根治性前列腺切除术对控尿可能有益的报道，已将其适应证扩展到了保留勃起功能之外。目前尚不清楚NS手术是否会影响肿瘤学结局。
确定根治性前列腺切除术中NS的程度是否会影响肿瘤学结局。
设计、地点和参与者：在一项2008 - 2011年比较开放和机器人辅助根治性前列腺切除术的前瞻性对照试验中，纳入了4003例患者，我们评估了在瑞典7个中心接受机器人辅助根治性前列腺切除术的2401例患者。对患者进行了8年的随访。
使用经过验证的患者问卷、患者访谈以及手术前、术后3个月、12个月、24个月、6年和8年的临床记录表格，评估复发和手术切缘阳性状态的数据。分别使用Cox回归和逻辑回归对复发和阳性手术切缘（PSM）的影响进行建模。
共有481名男性在随访期间出现PSM，467名经历了复发。无复发男性的中位随访时间为6.6年。NS程度不同，复发率无统计学显著差异。NS程度越高，PSM率显著越高：筋膜间NS，比值比（OR）2.32（95%置信区间[CI] 1.69 - 3.16）；筋膜内NS，OR 3.23（95% CI 2.17 - 4.80）。pT2期疾病且有PSM的患者复发率（风险比[HR] 3.32，95% CI 2.43 - 4.53）高于pT3期疾病且无PSM的患者（HR 2.08，95% CI 1.66 - 2.62）。缺乏对病理标本的中心审查是一个局限性。
更高程度的NS显著增加了PSM的风险，但未显著增加癌症复发的风险。结合NS手术已知的功能益处，这些结果强调了需要确定个体化的平衡。
在本报告中，我们研究了在瑞典7家医院为患者进行机器人辅助手术时，前列腺切除术中保留神经的方法对癌症结局的影响。我们发现，高度保留神经会增加手术标本边缘的癌症阳性率，而阳性手术切缘会增加前列腺癌复发的风险。
