Ditonno Francesco, Bologna Eugenio, Licari Leslie Claire, Franco Antonio, Cannoletta Donato, Checcucci Enrico, Veccia Alessandro, Bertolo Riccardo, Crivellaro Simone, Porpiglia Francesco, De Nunzio Cosimo, Antonelli Alessandro, Autorino Riccardo
Department of Urology, Rush University Medical Center, Chicago, IL, USA.
Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Prostate Cancer Prostatic Dis. 2024 Sep 4. doi: 10.1038/s41391-024-00891-3.
To compare surgical, pathological, and functional outcomes of patients undergoing NeuroSAFE-guided RARP vs. RARP alone.
In February 2024, a literature search and assessment was conducted through PubMed, Scopus, and Web of Science, to retrieve data of men with PCa (P) undergoing RARP with NeuroSAFE (I) versus RARP without NeuroSAFE (C) to evaluate surgical, pathological, oncological, and functional outcomes (O), across retrospective and/or prospective comparative studies (Studies). Surgical (operative time [OT], number of nerve-sparing [NS] RARP, number of secondary resections after NeuroSAFE), pathological (PSM), oncological (biochemical recurrence [BCR]), and functional (postoperative continence and sexual function recovery) outcomes were analyzed, using weighted mean difference (WMD) for continuous variables and odd ratio (OR) for dichotomous variables.
Overall, seven studies met the inclusion criteria (one randomized clinical trial, one prospective non-randomized trial and five retrospective studies) and were eligible for SR and MA. A total of 4,207 patients were included in the MA, with 2247 patients (53%) undergoing RARP with the addition of NeuroSAFE, and 1 960 (47%) receiving RARP alone. The addition of NeuroSAFE enhanced the likelihood of receiving a nerve-sparing (NS) RARP (OR 5.49, 95% CI 2.48-12.12, I = 72%). In the NeuroSAFE cohort, a statistically significant reduction in the likelihood of PSM at final pathology (OR 0.55, 95% CI 0.39-0.79, I = 73%) was observed. Similarly, a reduced likelihood of BCR favoring the NeuroSAFE was obtained (OR 0.47, 95% CI 0.35-0.62, I = 0%). At 12-month postoperatively, NeuroSAFE led to a significantly higher likelihood of being pad-free (OR 2.01, 95% CI 1.25-3.25, I = 0%), and of erectile function recovery (OR 3.50, 95% CI 2.34-5.23, I = 0%).
Available evidence suggests that NeuroSAFE might represent a histologically based approach to NVB preservation, broadening the indications of NS RARP, reducing the likelihood of PSM and subsequent BCR. In addition, it might translate into better functional postoperative outcomes. However, the current body of evidence is mostly derived from non-randomized studies with a high risk of bias.
比较接受神经安全引导下机器人辅助根治性前列腺切除术（NeuroSAFE-guided RARP）与单纯机器人辅助根治性前列腺切除术（RARP）患者的手术、病理和功能结果。
2024年2月，通过PubMed、Scopus和Web of Science进行文献检索和评估，以检索接受NeuroSAFE辅助RARP（I）与未接受NeuroSAFE的RARP（C）的前列腺癌（P）男性患者的数据，以评估手术、病理、肿瘤学和功能结果（O），纳入回顾性和/或前瞻性比较研究（研究）。分析手术（手术时间[OT]、保留神经[NS]的RARP数量、NeuroSAFE后二次切除数量）、病理（切缘阳性[PSM]）、肿瘤学（生化复发[BCR]）和功能（术后控尿和性功能恢复）结果，连续变量采用加权平均差（WMD），二分变量采用比值比（OR）。
总体而言，七项研究符合纳入标准（一项随机临床试验、一项前瞻性非随机试验和五项回顾性研究）， eligible for SR and MA。荟萃分析共纳入4207例患者，其中2247例（53%）接受了NeuroSAFE辅助的RARP，1960例（47%）仅接受了RARP。添加NeuroSAFE增加了接受保留神经（NS）RARP的可能性（OR 5.49，95%CI 2.48-12.12，I² = 72%）。在NeuroSAFE队列中，观察到最终病理时PSM可能性的统计学显著降低（OR 0.55，95%CI 0.39-0.79，I² = 73%）。同样，有利于NeuroSAFE的BCR可能性降低（OR 0.47，95%CI 0.35-0.62，I² = 0%）。术后12个月时，NeuroSAFE导致无尿垫的可能性显著更高（OR 2.01，95%CI 1.25-3.25，I² = 0%），以及勃起功能恢复的可能性更高（OR 3.50，95%CI 2.34-5.23，I² = 0%）。
现有证据表明，NeuroSAFE可能代表一种基于组织学的神经血管束保留方法，拓宽了NS RARP的适应症，降低了PSM和随后BCR的可能性。此外，它可能转化为更好的术后功能结果。然而，目前的证据大多来自偏倚风险高的非随机研究。
