The value of standardized intra-operative surgical margin assessment during prostate cancer operation

Michelle van der Slot

Research output: Types of ThesisDoctoral ThesisInternal

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One of the main treatment options for localised prostate cancer is radical prostatectomy. Radical prostatectomy is complicated by urinary incontinence and erectile dysfunction in 3-16% and 20-90% of men, respectively. Preservation of the neurovascular bundle adjacent to the prostate can reduce the incidence of these complications. However, nerve-sparing surgery may conversely lead to more frequent positive surgical margins. With intraoperative frozen sections (NeuroSAFE) during radical prostatectomy, the surgical margin of the prostate adjacent to the neurovascular bundle is assessed during the operation. The NeuroSAFE-technique thus may provide nerve-sparing surgery and reduce positive surgical margin involvement. Since the development of this technique by the Martini Klinik, several centres have implemented this procedure. However, the effects of this technique have not been validated in large independent cohorts. From September 2018 onwards, scheduled radical prostatectomies from eight centres in the Netherlands were concentrated in one centre utilising the NeuroSAFE technique.
In this thesis, we investigate the implementation and the impact of the NeuroSAFE technique in a high-volume centre in the Netherlands. We provided a detailed description of the NeuroSAFE procedure and clinical decision-making, which will facilitate its use in other hospitals and support comparability between centres. We showed that NeuroSAFE enabled more uni- and bilateral nerve-sparing surgery, while NeuroSAFE had no negative impact on positive surgical margin or oncological outcome at short term. Although we were not able to prospectively compare the functional outcomes with patients undergoing RP without NeuroSAFE, we showed that nerve-sparing surgery improved the erectile function and continence after surgery.
Original languageEnglish
Awarding Institution
  • Erasmus University Rotterdam
  • van Leenders, Arno, Supervisor
  • Bouts, Monique, Supervisor
  • den Bakker, Michael, Co-supervisor
Award date25 Oct 2023
Place of PublicationRotterdam
Publication statusPublished - 25 Oct 2023

Bibliographical note

Printing of this thesis was financially supported by: Stichting Wetenschappelijk Onderzoek Prostaatkanker (SWOP-Research), Erasmus University Medical Center, Department of Pathology of the Erasmus University Medical Center, ChipSoft, Ipsen Farmaceutica B.V., ABN AMRO


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