Oncological Safety of Intrafascial Nerve-sparing Radical Prostatectomy Compared with Conventional Process: a Pooled Review and Meta-regression Analysis Based on Available Studies

Overview

Journal BMC Urol

Publisher Biomed Central

Specialty Urology

Date 2019 May 29

PMID 31133039

Citations 3

Authors

Xiao Wang

Yiqi Wu

Jia Guo

Hui Chen

Xiaodong Weng

Xiuheng Liu

Affiliations

Soon will be listed here.

Abstract

Background: Intrafascial prostatectomy was a modified technique from the conventional nerve-sparing surgery in order to improve patients' post-surgical continence and erectile function; however, ongoing controversy exists regarding the oncological safety of this technique. In this study we aimed to provide a critical and pooled analysis based on published literatures regarding the oncological outcomes after intrafascial nerve-sparing prostatectomy.

Methods: Database searches were performed for published articles till June 2018 on PubMed. Three reviewers screened fulfilled papers and extracted data independently. Main outcome was the positive surgical margins (PSMs) rates stratified by pathological stages. We performed both one-arm and comparative meta-analysis to evaluate the oncological safety of intrafascial technique. Moreover, we built meta-regression models to assess the confounding factors.

Results: We retrieved a total of 117 records after electronic search, of which 21 studies were finally included in this review. There were 15 controlled studies and 6 surgical series. Our one-arm meta-analysis demonstrated that the total PSM rates after intrafascial techniques ranging from 2.2 to 35%, with a pooled rate of 14.5% on average (480 of 3151 patients, 95% confidence interval[CI]: 11.2-17.5%). Meta-regression model showed that patients' age, pT2 cancer percentage and Selection Score of Oncological Safety (SSOS) were significantly associated with total PSM rate; moreover, each 1 point of SSOS could decrease the total PSM rate by 1.3% on average. Comparative meta-analysis demonstrated that there was no significant difference between intra- and inter-fascial group regarding PSM rates.

Conclusions: With stringent case selection and when performed by experienced surgeons, intrafascial prostatectomy could offer an acceptable or, at least, equivalent PSM rate compared with the conventional interfascial approach. Preoperative SSOS more than 7 points could be considered as an indication of intrafascial radical prostatectomy.

Citing Articles

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Modified completely intrafascial radical cysprostatectomy for bladder cancer: a single-center, blinded, controlled study.

Wang X, Guo J, Wang L, Wang M, Weng X, Chen H BMC Cancer. 2021; 21(1):887.

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Robotic radical prostatectomy: analysis of midterm pathologic and oncologic outcomes: A historical series from a high-volume center.

Asimakopoulos A, Annino F, Mugnier C, Lopez L, Hoepffner J, Gaston R Surg Endosc. 2020; 35(12):6731-6745.

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References

DAmico A, Whittington R, Malkowicz S, Wu Y, Chen M, Art M . Combination of the preoperative PSA level, biopsy gleason score, percentage of positive biopsies, and MRI T-stage to predict early PSA failure in men with clinically localized prostate cancer. Urology. 2000; 55(4):572-7. DOI: 10.1016/s0090-4295(99)00479-3. View

Walsh P . Radical prostatectomy for localized prostate cancer provides durable cancer control with excellent quality of life: a structured debate. J Urol. 2000; 163(6):1802-7. View

Han M, Partin A, Pound C, Epstein J, Walsh P . Long-term biochemical disease-free and cancer-specific survival following anatomic radical retropubic prostatectomy. The 15-year Johns Hopkins experience. Urol Clin North Am. 2001; 28(3):555-65. DOI: 10.1016/s0094-0143(05)70163-4. View

Partin A, Mangold L, Lamm D, Walsh P, Epstein J, Pearson J . Contemporary update of prostate cancer staging nomograms (Partin Tables) for the new millennium. Urology. 2001; 58(6):843-8. DOI: 10.1016/s0090-4295(01)01441-8. View

Fromont G, Baumert H, Cathelineau X, Rozet F, Validire P, Vallancien G . Intraoperative frozen section analysis during nerve sparing laparoscopic radical prostatectomy: feasibility study. J Urol. 2003; 170(5):1843-6. DOI: 10.1097/01.ju.0000092081.71167.34. View

Eastham J, Kattan M, Riedel E, Begg C, Wheeler T, Gerigk C . Variations among individual surgeons in the rate of positive surgical margins in radical prostatectomy specimens. J Urol. 2003; 170(6 Pt 1):2292-5. DOI: 10.1097/01.ju.0000091100.83725.51. View

Costello A, Brooks M, Cole O . Anatomical studies of the neurovascular bundle and cavernosal nerves. BJU Int. 2004; 94(7):1071-6. DOI: 10.1111/j.1464-410X.2004.05106.x. View

Rassweiler J, Marrero R, Hammady A, Erdogru T, Teber D, Frede T . Transperitoneal laparoscopic radical prostatectomy: ascending technique. J Endourol. 2004; 18(7):593-9. DOI: 10.1089/end.2004.18.593. View

Menon M, Kaul S, Bhandari A, Shrivastava A, Tewari A, Hemal A . Potency following robotic radical prostatectomy: a questionnaire based analysis of outcomes after conventional nerve sparing and prostatic fascia sparing techniques. J Urol. 2005; 174(6):2291-6, discussion 2296. DOI: 10.1097/01.ju.0000181825.54480.eb. View

10.

Curto F, Benijts J, Pansadoro A, Barmoshe S, Hoepffner J, Mugnier C . Nerve sparing laparoscopic radical prostatectomy: our technique. Eur Urol. 2006; 49(2):344-52. DOI: 10.1016/j.eururo.2005.11.029. View

11.

Stolzenburg J, Rabenalt R, Tannapfel A, Liatsikos E . Intrafascial nerve-sparing endoscopic extraperitoneal radical prostatectomy. Urology. 2006; 67(1):17-21. DOI: 10.1016/j.urology.2005.09.052. View

12.

Atug F, Castle E, Srivastav S, Burgess S, Thomas R, Davis R . Positive surgical margins in robotic-assisted radical prostatectomy: impact of learning curve on oncologic outcomes. Eur Urol. 2006; 49(5):866-71. DOI: 10.1016/j.eururo.2006.02.054. View

13.

Savera A, Kaul S, Badani K, Stark A, Shah N, Menon M . Robotic radical prostatectomy with the "Veil of Aphrodite" technique: histologic evidence of enhanced nerve sparing. Eur Urol. 2006; 49(6):1065-73. DOI: 10.1016/j.eururo.2006.02.050. View

14.

Rassweiler J . Intrafascial nerve-sparing laproscopic radical prostatectomy: do we really preserve relevant nerve-fibres?. Eur Urol. 2006; 49(6):955-7. DOI: 10.1016/j.eururo.2006.03.053. View

15.

Kaul S, Menon M . Robotic radical prostatectomy: evolution from conventional to VIP. World J Urol. 2006; 24(2):152-60. DOI: 10.1007/s00345-006-0101-3. View

16.

Stolzenburg J, Rabenalt R, Do M, Schwalenberg T, Winkler M, Dietel A . Intrafascial nerve-sparing endoscopic extraperitoneal radical prostatectomy. Eur Urol. 2007; 53(5):931-40. DOI: 10.1016/j.eururo.2007.11.047. View

17.

Vickers A, Savage C, Hruza M, Tuerk I, Koenig P, Martinez-Pineiro L . The surgical learning curve for laparoscopic radical prostatectomy: a retrospective cohort study. Lancet Oncol. 2009; 10(5):475-80. PMC: 2777762. DOI: 10.1016/S1470-2045(09)70079-8. View

18.

Budaus L, Isbarn H, Schlomm T, Heinzer H, Haese A, Steuber T . Current technique of open intrafascial nerve-sparing retropubic prostatectomy. Eur Urol. 2009; 56(2):317-24. DOI: 10.1016/j.eururo.2009.05.044. View

19.

Potdevin L, Ercolani M, Jeong J, Kim I . Functional and oncologic outcomes comparing interfascial and intrafascial nerve sparing in robot-assisted laparoscopic radical prostatectomies. J Endourol. 2009; 23(9):1479-84. DOI: 10.1089/end.2009.0369. View

20.

Neill M, Louie-Johnsun M, Chabert C, Eden C . Does intrafascial dissection during nerve-sparing laparoscopic radical prostatectomy compromise cancer control?. BJU Int. 2010; 104(11):1730-3. DOI: 10.1111/j.1464-410x.2009.08670.x. View