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Nerve Sparing during Robot-Assisted Radical Prostatectomy Increases the Risk of Ipsilateral Positive Surgical Margins

2020; Lippincott Williams & Wilkins; Volume: 204; Issue: 1 Linguagem: Inglês

10.1097/ju.0000000000000760

1527-3792

Timo Soeterik, Harm H.E. van Melick, Lea M. Dijksman, Saskia P. Stomps, J. Alfred Witjes, J.P.A. Van Basten,

Vascular Procedures and Complications

No AccessJournal of UrologyAdult Urology1 Jul 2020Nerve Sparing during Robot-Assisted Radical Prostatectomy Increases the Risk of Ipsilateral Positive Surgical Margins T. F. W. Soeterik, H. H. E van Melick, L. M. Dijksman, S. Stomps, J. A. Witjes, and J. P. A. van Basten T. F. W. SoeterikT. F. W. Soeterik *Correspondence: Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands E-mail Address: [email protected] Department of Value-Based Healthcare, Santeon, Utrecht, The Netherlands , H. H. E van MelickH. H. E van Melick Department of Urology, St. Antonius Hospital, Nieuwegein-Utrecht, The Netherlands , L. M. DijksmanL. M. Dijksman Department of Value-Based Healthcare, St. Antonius Hospital, Nieuwegein-Utrecht, The Netherlands , S. StompsS. Stomps Department of Urology, Hospital Group Twente, Almelo-Hengelo, The Netherlands , J. A. WitjesJ. A. Witjes Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands , and J. P. A. van BastenJ. P. A. van Basten Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands View All Author Informationhttps://doi.org/10.1097/JU.0000000000000760AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Available published studies evaluating the association between nerve sparing robot-assisted radical prostatectomy and risk of ipsilateral positive surgical margins were subject to selection bias. In this study we overcome these limitations by using multivariable regression analysis. Materials and Methods: Patients undergoing robot-assisted radical prostatectomy for prostate cancer at 4 institutions from 2013 to 2018 were included in the study. A multilevel logistic random intercept model, including covariates on patient level and side specific factors on prostate lobe level, was used to evaluate the association between nerve sparing and risk of ipsilateral positive margins. Results: A total of 5,148 prostate lobes derived from 2,574 patients who underwent robot-assisted radical prostatectomy were analyzed. Multivariable analysis showed nerve sparing was an independent predictor for ipsilateral positive margins (OR 1.42, 95% CI 1.14–1.82). Other significant predictors for positive margins were prostate specific antigen density (OR 3.64, 95% CI 2.36–5.90) and side specific covariates including highest preoperative ISUP (International Society of Urological Pathology) biopsy grade (OR 1.58, 95% CI 1.13–2.53; OR 1.62, 95% CI 1.13–2.69; OR 2.11, 95% CI 1.39–3.59 and OR 4.43, 95% CI 3.17–10.12 for ISUP grade 2, 3, 4 and 5, respectively), presence of extraprostatic extension on magnetic resonance imaging (OR 1.42, 95% CI 1.03–1.91) and percentage of positive cores on systematic biopsy (OR 3.82, 95% CI 2.50–5.86). Conclusions: Nerve sparing was associated with an increased risk of ipsilateral positive surgical margins. 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Volume 204Issue 1July 2020Page: 91-95Supplementary Materials Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.Keywordsprostatic neoplasmsoutcomesprostatectomymargins of excisionMetricsAuthor Information T. F. W. Soeterik Department of Value-Based Healthcare, Santeon, Utrecht, The Netherlands *Correspondence: Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands E-mail Address: [email protected] More articles by this author H. H. E van Melick Department of Urology, St. Antonius Hospital, Nieuwegein-Utrecht, The Netherlands More articles by this author L. M. Dijksman Department of Value-Based Healthcare, St. Antonius Hospital, Nieuwegein-Utrecht, The Netherlands More articles by this author S. Stomps Department of Urology, Hospital Group Twente, Almelo-Hengelo, The Netherlands More articles by this author J. A. Witjes Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands More articles by this author J. P. A. van Basten Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands More articles by this author Expand All Supported by Astellas Pharma and Amgen. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Advertisement PDF DownloadLoading ...