Kupski Tomasz, Małek Michał, Mor Igal
Mazovia Hospital Warsaw, Department of Urology, Warsaw, Poland.
Cent European J Urol. 2021;74(4):491-495. doi: 10.5173/ceju.2021.0031. Epub 2021 Oct 13.
The aim of this study was to evaluate the risk of a positive margin in the intraoperative and final pathology depending on the risk group for biochemical recurrence in biopsy specimens after robot-assisted radical prostatectomy (RaRP) with sparing of the neurovascular bundles (NS).
The study was prospective and non-randomised. The intraoperative and final pathology examinations were performed in 65 consecutive patients treated with RaRP between 11.2019-08.2020. In the intraoperative examination, the site of the dissected neurovascular bundles and any suspicious places were examined. Patients were divided into 3 risk groups [according to the European Association of Urology (EAU) biochemical recurrence-risk stratification]. Due to the uncertain prognostic value of microscopic positive margins, 3 groups were identified: R0, Rmicro and R1.
In the intraoperative examination, the distribution of risk groups in R0, Rmicro and R1 groups is similar (p = 0.132). In the postoperative study, the distribution of risk groups in each margin group is different, and is statistically significant (p <0.001). It has been shown that an increase in the risk group is an indicator of the occurrence of a positive margin in the final histopathological result regardless of the inclusion of Rmicro into R1 or into R0 by 2.68 and 6.52 times, respectively.
The preoperative risk group is an important factor for the occurrence of a positive margin, but only in the final examination and not in the intraoperative one. An intraoperative examination of the neurovascular bundles only is pointless and should be extended to the examination of the apex.
本研究的目的是评估在保留神经血管束（NS）的机器人辅助根治性前列腺切除术（RaRP）后，根据活检标本中生化复发的风险组，术中及最终病理切缘阳性的风险。
本研究为前瞻性非随机研究。对2019年11月至2020年8月期间连续接受RaRP治疗的65例患者进行了术中及最终病理检查。在术中检查中，检查解剖的神经血管束部位及任何可疑部位。患者根据欧洲泌尿外科协会（EAU）生化复发风险分层分为3个风险组。由于显微镜下切缘阳性的预后价值不确定，确定了3组：R0、Rmicro和R1。
在术中检查中，R0、Rmicro和R1组的风险组分布相似（p = 0.132）。在术后研究中，各切缘组的风险组分布不同，且具有统计学意义（p <0.001）。结果表明，无论将Rmicro归入R1还是R0，风险组的增加分别是最终组织病理学结果中切缘阳性发生的指标，增加倍数分别为2.68倍和6.52倍。
术前风险组是切缘阳性发生的重要因素，但仅在最终检查中如此，在术中检查中并非如此。仅对神经血管束进行术中检查毫无意义，应扩展至对前列腺尖部的检查。
