The impact of 3D models on positive surgical margins after robot-assisted radical prostatectomy.

To evaluate the role of 3D models on positive surgical margin rate (PSM) rate in patients who underwent robot-assisted radical prostatectomy (RARP) compared to a no-3D control group. Secondarily, we evaluated the postoperative functional and oncological outcomes.

Prospective study enrolling patients with localized prostate cancer (PCa) undergoing RARP with mp-MRI-based 3D model reconstruction, displayed in a cognitive or augmented-reality fashion, at our Centre from 01/2016 to 01/2020. A control no-3D group was extracted from the last two years of our Institutional RARP database. PSMr between the two groups was evaluated and multivariable linear regression (MLR) models were applied. Finally, Kaplan-Meier estimator was used to calculate biochemical recurrence at 12 months after the intervention.

160 patients were enrolled in the 3D Group, while 640 were selected for the Control Group. A more conservative NS approach was registered in the 3D Group (full NS 20.6% vs 12.7%; intermediate NS 38.1% vs 38.0%; standard NS 41.2% vs 49.2%; p = 0.02). 3D Group patients had lower PSM rates (25 vs. 35.1%, p = 0.01). At MLR models, the availability of 3D technology (p = 0.005) and the absence of extracapsular extension (ECE, p = 0.004) at mp-MRI were independent predictors of lower PSMr. Moreover, 3D model represented a significant protective factor for PSM in patients with ECE or pT3 disease.

The availability of 3D models during the intervention allows to modulate the NS approach, limiting the occurrence of PSM, especially in patients with ECE at mp-MRI or pT3 PCa.

World journal of urology. 2022 Jul 05 [Epub ahead of print]

Enrico Checcucci, Angela Pecoraro, Daniele Amparore, Sabrina De Cillis, Stefano Granato, Gabriele Volpi, Michele Sica, Paolo Verri, Alberto Piana, Pietro Piazzolla, Matteo Manfredi, Enrico Vezzetti, Michele Di Dio, Cristian Fiori, Francesco Porpiglia, Uro-technology and SoMe Working Group of the Young Academic Urologists Working Party of the European Association of Urology

Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142, km 3, 95 10060, Candiolo, Turin, Italy. ., Division of Urology, Department of Oncology, University of Turin San Luigi Gonzaga Hospital, Orbassano, Turin, Italy., Department of Management and Production Engineer, Polytechnic University of Turin, Turin, Italy., Division of Urology, Department of Surgery, SS Annunziata Hospital, Cosenza, Italy.

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