TY - JOUR
T1 - Centralized prostatectomy with intraoperative NeuroSAFE margin assessment improves surgical margin control
AU - Kroon, Lisa J.
AU - Remmers, Sebastiaan
AU - Busstra, Martijn B.
AU - Gan, Melanie
AU - Klaver, Sjoerd
AU - Rietbergen, John B.W.
AU - van der Slot, Margaretha A.
AU - Hollemans, Eva
AU - Kweldam, Charlotte F.
AU - Bangma, Chris H.
AU - Roobol, Monique J.
AU - van Leenders, Geert J.L.H.
N1 - Publisher Copyright:
© 2024 The Author(s). Histopathology published by John Wiley & Sons Ltd.
PY - 2024/11
Y1 - 2024/11
N2 - Aims: To investigate the surgical margin status in patients with prostate cancer who underwent robot-assisted radical prostatectomy (RARP) with intraoperative neurovascular structure-adjacent frozen-section analysis (NeuroSAFE) and evaluate differences compared to patients who underwent radical prostatectomy without NeuroSAFE. Patients and Methods: Between September 2018 and January 2021, 962 patients underwent centralized RARP with NeuroSAFE. A secondary resection was performed in case of a positive surgical margin (PSM) on intraoperative frozen section (IFS) analysis to convert a PSM into a negative surgical margin (NSM). A retrospective cohort consisted of 835 patients who had undergone radical prostatectomy in a tertiary centre without NeuroSAFE between January 2000 and December 2017. We performed multivariable logistic regression to evaluate differences in risk of PSM between cohorts after controlling for clinicopathological variables. Results: Patients operated with NeuroSAFE in the centralized clinic had 29% PSM at a definitive pathological RP examination. The median cumulative length of definitive PSM was 1.1 mm (interquartile range: 0.4–3.8). Among 275 men with PSM, 136 (49%) had a cumulative length ≤1 mm and 198 (72%) ≤3 mm. After controlling for PSA, Grade group, cribriform pattern, pT-stage, and pN-stage, patients treated in the centralized clinic with NeuroSAFE had significantly lower odds on PSM (odds ratio [OR]: 0.70, 95% confidence interval [CI]: 0.56–0.88; P = 0.002), PSM length >1 mm (OR: 0.14, 95% CI: 0.09–0.22; P < 0.001), and >3 mm (OR: 0.21, 95% CI: 0.14–0.30; P < 0.001). Conclusion: This study provides a detailed overview of surgical margin status in a centralized RP NeuroSAFE cohort. Centralization with NeuroSAFE was associated with lower PSM rates and significantly shorter PSM cumulative lengths, indicating improved control of surgical margin status.
AB - Aims: To investigate the surgical margin status in patients with prostate cancer who underwent robot-assisted radical prostatectomy (RARP) with intraoperative neurovascular structure-adjacent frozen-section analysis (NeuroSAFE) and evaluate differences compared to patients who underwent radical prostatectomy without NeuroSAFE. Patients and Methods: Between September 2018 and January 2021, 962 patients underwent centralized RARP with NeuroSAFE. A secondary resection was performed in case of a positive surgical margin (PSM) on intraoperative frozen section (IFS) analysis to convert a PSM into a negative surgical margin (NSM). A retrospective cohort consisted of 835 patients who had undergone radical prostatectomy in a tertiary centre without NeuroSAFE between January 2000 and December 2017. We performed multivariable logistic regression to evaluate differences in risk of PSM between cohorts after controlling for clinicopathological variables. Results: Patients operated with NeuroSAFE in the centralized clinic had 29% PSM at a definitive pathological RP examination. The median cumulative length of definitive PSM was 1.1 mm (interquartile range: 0.4–3.8). Among 275 men with PSM, 136 (49%) had a cumulative length ≤1 mm and 198 (72%) ≤3 mm. After controlling for PSA, Grade group, cribriform pattern, pT-stage, and pN-stage, patients treated in the centralized clinic with NeuroSAFE had significantly lower odds on PSM (odds ratio [OR]: 0.70, 95% confidence interval [CI]: 0.56–0.88; P = 0.002), PSM length >1 mm (OR: 0.14, 95% CI: 0.09–0.22; P < 0.001), and >3 mm (OR: 0.21, 95% CI: 0.14–0.30; P < 0.001). Conclusion: This study provides a detailed overview of surgical margin status in a centralized RP NeuroSAFE cohort. Centralization with NeuroSAFE was associated with lower PSM rates and significantly shorter PSM cumulative lengths, indicating improved control of surgical margin status.
UR - http://www.scopus.com/inward/record.url?scp=85200471831&partnerID=8YFLogxK
U2 - 10.1111/his.15291
DO - 10.1111/his.15291
M3 - Article
C2 - 39108215
AN - SCOPUS:85200471831
SN - 0309-0167
VL - 85
SP - 760
EP - 768
JO - Histopathology
JF - Histopathology
IS - 5
ER -