The clinical question was simple but important. Can we preserve more neurovascular benefit issue during the radical prostatectomy and improve this way the functional recovery and still maintain oncological safety? NeuroSAFE is an intraoperative frozen section technique that evaluates the surgical margin I just sent to the neurovascular band in real time. This allows us to tailor the nerve sparing approach during the operation rather than relying only on the preoperative risk assessment.
We include the 13 comparative studies published between 2012 and 2025, comprising over 22,000 patients. The evidence based included two randomized control studies and 11 observational cohort studies. The NeuroSAFE was associated with significantly better postoperative function, with odds rate of two. It was also associated with improvement in urinary continence recovery with odds ratio of 1.36. From an oncological standpoint, NeuroSAFE was associated with a significant reduction in positive surgical margins. The pooled odds ratio was 0.73.
Importantly, there was no significant difference between both groups when we analyzed biochemical recurrence, but there was a trade off. NeuroSAFE increased operative time by a mean approximately 36 minutes. This reflects probably the need for intraoperative frozen section processing and pathology support. The key message is that NeuroSAFE may help surgeons more beyond the traditional binary decision of neurosparing versus no-neurosparing surgery. I hope you enjoy the reads.