- 作者：Thorsten Schlomm ; Pierre Tennstedt ; Caroline Huxhold ; Thomas Steuber ; Georg Salomon ; Uwe Michl ; Hans Heinzer ; Jens Hansen ; Lars Bud?us ; Stefan Steurer ; Corinna Wittmer ; Sarah Minner ; Alex ; er Haese ; Guido Sauter ; Markus Graefen ; Hartwig Hul
- 关键词：Prostate ; Prostate cancer ; Nerve-sparing radical prostatectomy ; Surgery ; Nerve-sparing ; Frozen section ; Surgical margin ; Propensity score
- 刊名：European Urology
- 出版年：2012
- 出版时间：August, 2012
- 年：2012
- 卷：62
- 期：2
- 页码：333-340
- 全文大小：551 K
Background
Intraoperative frozen-section analysis allows real-time histologic assessment of surgical margins (SMs) and identification of candidates for nerve-sparing (NS) procedures.Objective
To examine the efficacy and oncologic safety of a systematic neurovascular structure-adjacent frozen-section examination (NeuroSAFE) during NS radical prostatectomy (RP).
Design, setting, and participants
From January 2002 to June 2011, 11 069 consecutive RPs were performed at the University Medical Center Hamburg-Eppendorf. Of these, 5392 (49 % ) were conducted with NeuroSAFE.
Surgical procedure
Our NeuroSAFE approach included the whole laterorectal circumference of the prostate to determine the SM status of the complete neurovascular tissue-corresponding prostatic surface.
Outcome measurements and statistical analysis
The impact of NeuroSAFE on NS frequency, SM status, and biochemical recurrence (BCR) was analyzed by chi-square test, and by Kaplan-Meier analyses in propensity score-based matched cohorts.
Results and limitations
Positive SMs (PSMs) were detected in 1368 (25 % ) NeuroSAFE RPs, leading to a secondary resection of the ipsilateral neurovascular tissue. Secondary wide resection resulted in conversion to a definitive negative SM (NSM) status in 1180 (86 % ) patients. In NeuroSAFE RPs, frequency of NS was significantly higher (all stages: 97 % vs 81 % ; pT2: 99 % vs 92 % ; pT3a: 94 % vs 72 % ; pT3b: 88 % vs 40 % ; p < 0.0001) and PSM rates were significantly lower (all stages: 15 % vs 22 % ; pT2: 7 % vs 12 % ; pT3a: 21 % vs 32 % ; p < 0.0001) than in the matched non-NeuroSAFE RPs. In propensity score-based comparisons, NeuroSAFE had no negative impact on BCR (pT2, p = 0.06; pT3a, p = 0.17, pT3b, p = 0.99), and BCR-free survival of patients with conversion to NSM did not differ significantly from patients with primarily NSM (pT2, p = 0.16; pT3, p = 0.26). The accuracy of our NeuroSAFE approach was 97 % with a false-negative rate of 2.5 % . The major limitations of this study are its retrospective nature and relatively short follow-up.
Conclusions
NeuroSAFE enables real-time histologic monitoring of the oncologic safety of a NS procedure. Systematic NeuroSAFE significantly increases NS frequencies and reduces PSMs. Patients with a NeuroSAFE-detected PSM could be converted to a prognostically more favorable NSM status by secondary wide resection.