1551 NERVE-SPARING ROBOTIC PROSTATECTOMY IN PREOPERATIVELY HIGH-RISK PATIENTS IS SAFE AND EFFICACIOUS

Abstract

You have accessJournal of UrologyProstate Cancer: Localized VI1 Apr 20101551 NERVE-SPARING ROBOTIC PROSTATECTOMY IN PREOPERATIVELY HIGH-RISK PATIENTS IS SAFE AND EFFICACIOUS Hugh Lavery, Fatima Nabizada-Pace, John Carlucci, and David Samadi Hugh LaveryHugh Lavery More articles by this author , Fatima Nabizada-PaceFatima Nabizada-Pace More articles by this author , John CarlucciJohn Carlucci More articles by this author , and David SamadiDavid Samadi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1316AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Given the higher likelihood of extraprostatic extension in high-risk patients, many urologists will sacrifice the neurovascular bundles (NVB) in such patients in an attempt to decrease the risk of positive surgical margins. In contrast, we frequently perform nerve-sparing in high-risk patients. We analyzed our outcomes in patients with preoperatively high-risk prostate cancer according to the D'Amico risk group classification, and stratified by nerve-sparing status. METHODS An institutional database of 1420 robotic-assisted laparoscopic prostatectomies (RALP) was queried for patients presenting with PSA > 20 ng/ml, Gleason 8 or higher on biopsy, or clinical stage T2c or higher. Interfascial nerve-sparing was performed whenever oncologically feasible. All patients with clear extracapsular extension of tumor had wide excision of the NVB on the affected side. Additional patients with high volume of high grade disease also had NVBs sacrificed on the side(s) of the adverse features. In the remaining patients, the decision to perform nerve-sparing was based on a combination of preoperative characteristics and intraoperative observations. RESULTS Of the 1420 RALP, 129 patients (9%) were considered high risk. Adequate follow-up was available in 106, who constituted the study population. Mean serum PSA was 11.2. Bilateral, unilateral and non-nerve sparing was performed on 59%, 14% and 27%, respectively. Baseline demographics are shown in the table. On final histopathology, 42% were organ confined; 52 patients had extraprostatic extension and 34 had seminal vesicle invasion. Positive surgical margins occurred in 33%: 14% focal and 19% extensive. Favorable pathologic outcomes (organ-confined and negative surgical margins) were observed in 40%. At a median follow-up of 11 months, biochemical recurrence occurred in 20%. Nerve sparing was associated with more favorable pathologic features, possibly due to selection bias. When controlling for adverse pathologic features, nerve sparing was not associated with higher rates of positive surgical margins or biochemical recurrence. Continence and potency rates were 81% and 50%, respectively. The “trifecta” of continence, potency and freedom from recurrence was achieved in 25 patients (24%). CONCLUSIONS Nerve-sparing robotic-assisted laparoscopic prostatectomy can safely be performed in patients with preoperatively high risk prostate cancer. Histopathologic and short-term oncologic outcomes at 11 month median follow-up are comparable to those in open surgical series from similar cohorts. New York, NY© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e598-e599 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hugh Lavery More articles by this author Fatima Nabizada-Pace More articles by this author John Carlucci More articles by this author David Samadi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...