Moritz J Reike, Karl H Tully, Maximilian Schulmeier, Alina Reicherz, Henning Bahlburg, Guido Müller, Peter Bach, Carlo Sternemann, Andrea Tannapfel, Joachim Noldus, Marko Brock, Florian Roghmann
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引用次数: 0
Abstract
Purpose: Patients with an intermediate risk prostate cancer (PCa) are not routinely offered nerve sparing (NS). Implementation of whole surface frozen section (FS) made NS-radical prostatectomy (RP) available and oncologically safe. In the present study, we aimed to assess the impact of the addition of FS on NS during RP and potentially improved functional outcomes.
Methods: Institutional data of patients (PSA ≤ 20 ng/mL, Gleason-Score ≤ 7, cT1c-cT2c) undergoing RP between 06/2011 and 11/2014 were prospectively collected. Decision for NS was made by the surgeon supported by FS. Only patients with a preoperative International Index of Erectile Function (IIEF-5) ≥ 17 were analyzed for potency. Continence was defined as pad use of ≤ 1 pad/day. Separate multivariable regression analyses were employed to examine predictors for both endpoints (i.e., potency and continence).
Results: Overall, 702 patients were included in this study. Final nerve-sparing surgery was performed in 671 patients (95.6%). Before the introduction of FS, only 392 patients (56%) would have undergone NS-RP. FS enabled intraoperative/final NS for 688 (98%) and 666 (95%) patients. No differences at overall follow-up between low- and intermediate-risk patients regarding continence (n = 122 (84.1%) vs. n = 223 (82.6%), p = 0.689) and potency (IIEF-5 ≥ 17, n = 16/47 vs. 26/68, p = 0.646) were detected. Surgeon volume was associated with improved continence (OR 3.69, 95% CI 1.86-7.32, p < 0.001) and erectile function (EF) (OR 2.49, 95% CI 1.23-5.03, p = 0.011).
Conclusion: The introduction of FS expanded NS to patients with an intermediate-risk PCa and selected high-risk PCa. This may lead to improved functional outcomes as more patients were eligible for NS.
目的：中危前列腺癌（PCa）患者不常规给予神经保留（NS）。全表面冷冻切片（FS）的实施使ns根治性前列腺切除术（RP）可行且肿瘤安全。在本研究中，我们旨在评估在RP期间添加FS对NS的影响以及可能改善的功能结果。方法：前瞻性收集2011年6月至2014年11月接受RP的患者（PSA≤20 ng/mL, Gleason-Score≤7,cT1c-cT2c）的机构资料。在FS的支持下，由外科医生作出NS的决定。仅对术前国际勃起功能指数(IIEF-5)≥17的患者进行效力分析。尿失禁定义为尿垫使用≤1块/天。采用单独的多变量回归分析来检查两个终点（即效价和尿失禁）的预测因子。结果：本研究共纳入702例患者。671例患者（95.6%）最终行保神经手术。在引入FS之前，只有392例（56%）患者会接受NS-RP。FS使688例（98%）和666例（95%）患者的术中/最终NS得以实现。低危和中危患者在尿失禁(n = 122 （84.1%) vs. n = 223 (82.6%), p = 0.689）和效价（IIEF-5≥17,n = 16/47 vs. 26/68, p = 0.646）方面的总体随访无差异。手术量与尿失禁的改善相关（OR 3.69, 95% CI 1.86-7.32, p）结论：FS的引入将NS扩展到中危PCa患者和部分高危PCa患者。这可能导致功能结果的改善，因为更多的患者符合nsns的条件。
期刊介绍：
International Journal of Urology is the official English language journal of the Japanese Urological Association, publishing articles of scientific excellence in urology. Submissions of papers from all countries are considered for publication. All manuscripts are subject to peer review and are judged on the basis of their contribution of original data and ideas or interpretation.
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