Intrafascial dissection significantly increases positive surgical margin and biochemical recurrence rates after robotic-assisted radical prostatectomy - Abstract

Introduction: Improved visualization and magnification in robot-assisted laparoscopic radical prostatectomy (RALRP) has tempted many urologists to dissect the neurovascular bundle closer to the prostate following the layers of the pseudo-capsule of the prostate.

This might bear a higher risk of decreased tumor control.

Materials and Methods: An analysis of a consecutive series of 186 patients who underwent RALRP at our institution was performed. The outcome of patients with intrafascial nerve-sparing (INS) was compared with the outcome of patients who underwent interfascial, extrafascial or no nerve-sparing (non-INS).

Results: A total of 80 patients (43.0%) received INS. The overall R1 rate was 27.9%. For pT2 tumors the rate of R1 was 33.8% in INS versus 14.8% in non-INS (odds ratio 2.936, 95% confidence interval 1.338-6.443, p = 0.007). Recurrence-free survival was significantly shorter in INS (p = 0.05; hazard ratio 3.791).

Conclusion: The intrafascial dissection technique for RALRP bears a high risk of incomplete resection in localized prostate cancer resulting in unfavorable outcome.

Written by:
Mortezavi A, Hermanns T, Seifert HH, Wild PJ, Schmid DM, Sulser T, Eberli D.   Are you the author?
Department of Urology, University Hospital Zürich, University of Zürich, Zürich, Switzerland.

Reference: Urol Int. 2012;89(1):17-24.
doi: 10.1159/000339254

PubMed Abstract
PMID: 22738925 Prostate Cancer Section