Safety of selective nerve sparing in high risk prostate cancer during robot-assisted radical prostatectomy

Anup Kumar, Srinivas Samavedi, Anthony S. Bates, Vladimir Mouraviev, Rafael F. Coelho, Bernardo Rocco, Vipul R. Patel

Research output: Contribution to journalArticlepeer-review

Abstract

D’Amico high risk prostate cancer is associated with higher incidence of extra prostatic disease. It is recommended to avoid nerve sparing in high risk patients to avoid residual cancer. We report our intermediate term oncologic and functional outcomes in patients with preoperative D’Amico high risk prostate cancer, who underwent selective nerve sparing robot-assisted radical prostatectomy (RARP). Between Jan 2008 till June 2013, 557 patients underwent RARP for D’Amico high risk prostate cancer. The criteria for nerve sparing were as follows—complete: non palpable disease with 0.05). The overall biochemical recurrence (BCR) rate at mean follow-up of 24.3 months was 19.21 %. The continence rate at 3 month was significantly higher in complete NS group in comparison to non-NS group (p = 0.020), however, this difference was not statistically significant at 1 year. Similarly, mean time to continence was significantly lower in complete NS group in comparison to non-NS group (p = 0.030). The potency rate was significantly higher and mean time to potency was significantly lower in complete NS group in comparison to non-NS group (p = 0.010 and 0.020, respectively). In high risk prostate cancer patients, selective nerve sparing during RARP, using the preoperative clinical variables (clinical stage and positive cores on biopsy) and surgeon’s intraoperative perception, could provide reasonable intermediate term oncologic, functional outcomes (continence and potency) with acceptable perioperative morbidity and positive surgical margins rate. Use of these preoperative factors and surgeon’s intraoperative judgment can appropriately evaluate high risk prostate cancer patients for nerve sparing RARP.

Original languageEnglish
Pages (from-to)1-10
Number of pages10
JournalJournal of Robotic Surgery
DOIs
Publication statusAccepted/In press - Jul 19 2016

Keywords

  • High risk prostate cancer
  • Nerve sparing
  • Prostatectomy
  • Robotic assisted radical prostatectomy

ASJC Scopus subject areas

  • Surgery
  • Health Informatics

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