Capsular incision in normal prostatic tissue during robot-assisted radical prostatectomy: a new concept or a waste of time?

Abstract

Capsular incision in normal prostatic tissue is not a predictive factor of PSM but reflected risk-taking during surgery especially when NVB preservation is indicated in low-risk prostate cancer. It can therefore only be considered a means to evaluate a surgical technique, but not a real predictor of PSM.

Prostatic capsular incision during radical prostatectomy has important oncological implications: a systematic review and meta‐analysis

“…Kwak et al showed this association on univariate analysis but not on multivariable analysis. Koutlidis et al also failed to show a link between NVB preservation and risk of CapI in their multivariable analysis. Despite attempts to determine whether ORP carries more risk than the minimally invasive alternative surgical approaches (LRP or RARP) in CapI risk, the evidence available is not clear.…”

“…Most of the factors that appear to be independent prognosticators of CapI are surgery‐specific. One study found that performing an extended pelvic lymph node dissection (ePLND) was associated with a reduced risk of CapI (OR 0.291, 95% CI 0.1–0.88; P = 0.03) . Whilst, surgeon experience was identified as a potential risk factor for CapI by two studies.…”

“…Body mass index (BMI) has been described to be an important patient-specific factor that independently predicts the occurrence of CapI. Two studies found a significant risk of CapI with increasing patient BMI [25,26], although Koutlidis et al [27] failed to show such an association. Other patient-specific factors, such as age, were not associated with an increased risk of CapI, although Odisho et al [28] found that Caucasian race carried an increased risk of CapI (OR 2.31, 95% CI 1.14-4.64; P = 0.03).…”

“…Whilst most studies consider CapI to be a histological phenomenon occurring in only pT2 disease and consider EPE separately, Barocas et al [13] broadened the definition of CapI to ensure the inclusion of all cases independent of SM status, and the presence or absence of EPE. Other studies in contrast define CapI as that occurring within benign/normal prostatic tissue only [15,27,28]. Mandel et al [12] uniquely defined CapI surgically (rather than pathologically) with the capsular breach being documented in the operating note by the surgeon performing the operation.…”