Francesco Ditonno, Eugenio Bologna, Leslie Claire Licari, Antonio Franco, Donato Cannoletta, Enrico Checcucci, Alessandro Veccia, Riccardo Bertolo, Simone Crivellaro, Francesco Porpiglia, Cosimo De Nunzio, Alessandro Antonelli, Riccardo Autorino
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Surgical (operative time [OT], number of nerve-sparing [NS] RARP, number of secondary resections after NeuroSAFE), pathological (PSM), oncological (biochemical recurrence [BCR]), and functional (postoperative continence and sexual function recovery) outcomes were analyzed, using weighted mean difference (WMD) for continuous variables and odd ratio (OR) for dichotomous variables.</p><p><strong>Results: </strong>Overall, seven studies met the inclusion criteria (one randomized clinical trial, one prospective non-randomized trial and five retrospective studies) and were eligible for SR and MA. A total of 4,207 patients were included in the MA, with 2247 patients (53%) undergoing RARP with the addition of NeuroSAFE, and 1 960 (47%) receiving RARP alone. The addition of NeuroSAFE enhanced the likelihood of receiving a nerve-sparing (NS) RARP (OR 5.49, 95% CI 2.48-12.12, I<sup>2</sup> = 72%). In the NeuroSAFE cohort, a statistically significant reduction in the likelihood of PSM at final pathology (OR 0.55, 95% CI 0.39-0.79, I<sup>2</sup> = 73%) was observed. Similarly, a reduced likelihood of BCR favoring the NeuroSAFE was obtained (OR 0.47, 95% CI 0.35-0.62, I<sup>2</sup> = 0%). At 12-month postoperatively, NeuroSAFE led to a significantly higher likelihood of being pad-free (OR 2.01, 95% CI 1.25-3.25, I<sup>2</sup> = 0%), and of erectile function recovery (OR 3.50, 95% CI 2.34-5.23, I<sup>2</sup> = 0%).</p><p><strong>Conclusion: </strong>Available evidence suggests that NeuroSAFE might represent a histologically based approach to NVB preservation, broadening the indications of NS RARP, reducing the likelihood of PSM and subsequent BCR. In addition, it might translate into better functional postoperative outcomes. However, the current body of evidence is mostly derived from non-randomized studies with a high risk of bias.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":null,"pages":null},"PeriodicalIF":5.1000,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Neurovascular structure-adjacent frozen-section examination (NeuroSAFE) during robot-assisted radical prostatectomy: a systematic review and meta-analysis of comparative studies.\",\"authors\":\"Francesco Ditonno, Eugenio Bologna, Leslie Claire Licari, Antonio Franco, Donato Cannoletta, Enrico Checcucci, Alessandro Veccia, Riccardo Bertolo, Simone Crivellaro, Francesco Porpiglia, Cosimo De Nunzio, Alessandro Antonelli, Riccardo Autorino\",\"doi\":\"10.1038/s41391-024-00891-3\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>To compare surgical, pathological, and functional outcomes of patients undergoing NeuroSAFE-guided RARP vs. RARP alone.</p><p><strong>Methods: </strong>In February 2024, a literature search and assessment was conducted through PubMed<sup>®</sup>, Scopus<sup>®</sup>, and Web of Science<sup>™</sup>, to retrieve data of men with PCa (P) undergoing RARP with NeuroSAFE (I) versus RARP without NeuroSAFE (C) to evaluate surgical, pathological, oncological, and functional outcomes (O), across retrospective and/or prospective comparative studies (Studies). Surgical (operative time [OT], number of nerve-sparing [NS] RARP, number of secondary resections after NeuroSAFE), pathological (PSM), oncological (biochemical recurrence [BCR]), and functional (postoperative continence and sexual function recovery) outcomes were analyzed, using weighted mean difference (WMD) for continuous variables and odd ratio (OR) for dichotomous variables.</p><p><strong>Results: </strong>Overall, seven studies met the inclusion criteria (one randomized clinical trial, one prospective non-randomized trial and five retrospective studies) and were eligible for SR and MA. A total of 4,207 patients were included in the MA, with 2247 patients (53%) undergoing RARP with the addition of NeuroSAFE, and 1 960 (47%) receiving RARP alone. The addition of NeuroSAFE enhanced the likelihood of receiving a nerve-sparing (NS) RARP (OR 5.49, 95% CI 2.48-12.12, I<sup>2</sup> = 72%). 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引用次数: 0
摘要
背景：比较在 NeuroSAFE 引导下进行 RARP 与单纯 RARP 患者的手术、病理和功能结果：比较在 NeuroSAFE 引导下接受 RARP 与单独接受 RARP 患者的手术、病理和功能结果：2024年2月，我们通过PubMed®、Scopus®和Web of Science™进行了文献检索和评估，检索了接受NeuroSAFE引导的RARP（I）与不接受NeuroSAFE引导的RARP（C）的男性PCa（P）患者的数据，以评估回顾性和/或前瞻性比较研究（研究）的手术、病理、肿瘤和功能结果（O）。对手术（手术时间[OT]、神经保留[NS]RARP次数、NeuroSAFE术后二次切除次数）、病理（PSM）、肿瘤（生化复发[BCR]）和功能（术后失禁和性功能恢复）结果进行分析，连续变量采用加权平均差（WMD），二分变量采用奇数比（OR）：共有七项研究符合纳入标准（一项随机临床试验、一项前瞻性非随机试验和五项回顾性研究），并符合SR和MA标准。共有4207名患者纳入了MA，其中2247名患者（53%）在接受RARP治疗的同时加用了NeuroSAFE，1960名患者（47%）仅接受了RARP治疗。加用NeuroSAFE提高了接受保留神经（NS）RARP的可能性（OR 5.49，95% CI 2.48-12.12，I2 = 72%）。在NeuroSAFE队列中，最终病理结果显示PSM的可能性有统计学意义的显著降低（OR 0.55，95% CI 0.39-0.79，I2 = 73%）。同样，NeuroSAFE 患者的 BCR 概率也有所降低（OR 0.47，95% CI 0.35-0.62，I2 = 0%）。术后 12 个月，NeuroSAFE 使患者无尿垫（OR 2.01，95% CI 1.25-3.25，I2 = 0%）和勃起功能恢复（OR 3.50，95% CI 2.34-5.23，I2 = 0%）的可能性显著增加：现有证据表明，NeuroSAFE可能代表了一种基于组织学的NVB保留方法，扩大了NS RARP的适应症，降低了PSM和后续BCR的可能性。此外，它还可能带来更好的术后功能预后。然而，目前的证据大多来自非随机研究，存在较高的偏倚风险。
Neurovascular structure-adjacent frozen-section examination (NeuroSAFE) during robot-assisted radical prostatectomy: a systematic review and meta-analysis of comparative studies.
Background: To compare surgical, pathological, and functional outcomes of patients undergoing NeuroSAFE-guided RARP vs. RARP alone.
Methods: In February 2024, a literature search and assessment was conducted through PubMed®, Scopus®, and Web of Science™, to retrieve data of men with PCa (P) undergoing RARP with NeuroSAFE (I) versus RARP without NeuroSAFE (C) to evaluate surgical, pathological, oncological, and functional outcomes (O), across retrospective and/or prospective comparative studies (Studies). Surgical (operative time [OT], number of nerve-sparing [NS] RARP, number of secondary resections after NeuroSAFE), pathological (PSM), oncological (biochemical recurrence [BCR]), and functional (postoperative continence and sexual function recovery) outcomes were analyzed, using weighted mean difference (WMD) for continuous variables and odd ratio (OR) for dichotomous variables.
Results: Overall, seven studies met the inclusion criteria (one randomized clinical trial, one prospective non-randomized trial and five retrospective studies) and were eligible for SR and MA. A total of 4,207 patients were included in the MA, with 2247 patients (53%) undergoing RARP with the addition of NeuroSAFE, and 1 960 (47%) receiving RARP alone. The addition of NeuroSAFE enhanced the likelihood of receiving a nerve-sparing (NS) RARP (OR 5.49, 95% CI 2.48-12.12, I2 = 72%). In the NeuroSAFE cohort, a statistically significant reduction in the likelihood of PSM at final pathology (OR 0.55, 95% CI 0.39-0.79, I2 = 73%) was observed. Similarly, a reduced likelihood of BCR favoring the NeuroSAFE was obtained (OR 0.47, 95% CI 0.35-0.62, I2 = 0%). At 12-month postoperatively, NeuroSAFE led to a significantly higher likelihood of being pad-free (OR 2.01, 95% CI 1.25-3.25, I2 = 0%), and of erectile function recovery (OR 3.50, 95% CI 2.34-5.23, I2 = 0%).
Conclusion: Available evidence suggests that NeuroSAFE might represent a histologically based approach to NVB preservation, broadening the indications of NS RARP, reducing the likelihood of PSM and subsequent BCR. In addition, it might translate into better functional postoperative outcomes. However, the current body of evidence is mostly derived from non-randomized studies with a high risk of bias.
期刊介绍：
Prostate Cancer and Prostatic Diseases covers all aspects of prostatic diseases, in particular prostate cancer, the subject of intensive basic and clinical research world-wide. The journal also reports on exciting new developments being made in diagnosis, surgery, radiotherapy, drug discovery and medical management.
Prostate Cancer and Prostatic Diseases is of interest to surgeons, oncologists and clinicians treating patients and to those involved in research into diseases of the prostate. The journal covers the three main areas - prostate cancer, male LUTS and prostatitis.
Prostate Cancer and Prostatic Diseases publishes original research articles, reviews, topical comment and critical appraisals of scientific meetings and the latest books. The journal also contains a calendar of forthcoming scientific meetings. The Editors and a distinguished Editorial Board ensure that submitted articles receive fast and efficient attention and are refereed to the highest possible scientific standard. A fast track system is available for topical articles of particular significance.
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