Neurovascular bundle preservation improves postoperative continence recovery in robotic-assisted laparoscopic radical prostatectomy after neoadjuvant hormonal therapy in the treatment of locally advanced prostate cancer: results from a propensity score-matched analysis.

Abstract

Objective: To evaluate the oncological outcomes and continence recovery of neoadjuvant hormonal therapy (NHT) before robot-assisted laparoscopic radical prostatectomy (RARP) with neurovascular bundle (NVB) preservation in patients with locally advanced prostate cancer (LAPC).

Methods: Of the 576 patients with LAPC who underwent RARP during January 2016-March 2024, those who received NHT before RARP with NVB preservation (NVB-RARP) were propensity score (PS)-matched with those undergoing RARP without NVB preservation (NNVB-RARP) based on preoperative and histological characteristics. Clinical and biochemical recurrence results were evaluated post-surgically, and postoperative continence was analyzed in the two groups using Kaplan-Meier curves.

Results: After PS matching, each group was matched with 77 patients. When compared with the NNVB-RARP group, the NVB-RARP group did not show any significant difference in the operation time (102.72 ± 11.64 min vs.105.05 ± 16.73 min, p = 0.319), postoperative hospitalization time (5.01 ± 0.80 d vs. 5.21 ± 1.13 d, p = 0.248), intraoperative bleeding (158.43 ± 13.76 mL vs. 161.23 ± 15.15 mL, p = 0.232), pathologic tumor stage (≤ pT2) (53.25% vs. 50.65%, p = 0.747), lymph node status (N1) (27.27% vs. 36.36%, p = 0.226), pathological Gleason score (≥ 8) (81.82% vs. 76.62%, p = 0.427), positive surgical margin (15.58% vs. 20.78%, p = 0.403), or complications (9.10% vs.11.69%, p = 0.597). The NVB-RARP group demonstrated significantly faster continence recovery than the NNVB-RARP group (recovery rates: 1 month 42.86% vs. 16.88%, p < 0.001, 3 months 62.34% vs. 36.36%, p = 0.001, and 12 months 83.12% vs. 66.23%, p = 0.016).

Conclusion: The present findings suggest that NHT before RARP with NVB preservation may enhance continence recovery without compromising the oncological outcomes in patients with LAPC.