Abstract:Introduction: Improved visualization and magnification in robot-assisted laparoscopic radical prostatectomy (RALRP) has tempted many urologists to dissect the neurovascular bundle closer to the prostate following the layers of the pseudo-capsule of the prostate. This might bear a higher risk of decreased tumor control. Materials and Methods: An analysis of a consecutive series of 186 patients who underwent RALRP at our institution was performed. The outcome of patients with intrafascial nerve-sparing (INS) was… Show more
“…PSM rates of intrafascial group stratified by pathological tumor stages could be found in Additional files 2 and 3, which showed that the pooled PSM rate was 9.7% (236/2423, 95% CI: 7.0–12.4%) in pT2 cancers (Additional file 2: Figure S1) and 44.0% (208/527, 95% CI: 34.9–53.2%) in pT3 cancer (Additional file 3: Figure S2). Overlapping higher rates could be seen in terms of the PSM rate in pT2 cancer that the studies of Curto (2006) [11] and Mortezavi (2012) [16], which also reported a significantly higher PSM rate than the pooled rate; however, this overlap was not observed with regard to the PSM rate in pT3 cancer.Fig. 2Forest plot for one-arm meta-analysis of studies adopting the intrafascial technique in terms of total PSM rate in all-stage disease stratified by surgical types.…”
Section: Resultsmentioning
confidence: 95%
“…It was possible to calculate the heterogeneity among the included studies as I 2 was 86.38%. Three studies showed significantly higher PSM rates than the pooled rate, which included the studies of Curto 2006 [11], Choi 2012 [18], and Mortezavi 2012 [16], with a PSM rate of 30.8% (127/413, 95% CI: 26.3–35.2%), 34% (17/50, 95% CI: 20.9–47.1%), and 35% (28/80, 95% CI: 24.5–45.5%), respectively, whereas the VIP team reported a notably lower PSM rate of 1/46 [27]. No obvious differences could be detected among the 3 surgery types of LRP, RRP, and RALRP.…”
Background
Intrafascial prostatectomy was a modified technique from the conventional nerve-sparing surgery in order to improve patients’ post-surgical continence and erectile function; however, ongoing controversy exists regarding the oncological safety of this technique. In this study we aimed to provide a critical and pooled analysis based on published literatures regarding the oncological outcomes after intrafascial nerve-sparing prostatectomy.
Methods
Database searches were performed for published articles till June 2018 on PubMed. Three reviewers screened fulfilled papers and extracted data independently. Main outcome was the positive surgical margins (PSMs) rates stratified by pathological stages. We performed both one-arm and comparative meta-analysis to evaluate the oncological safety of intrafascial technique. Moreover, we built meta-regression models to assess the confounding factors.
Results
We retrieved a total of 117 records after electronic search, of which 21 studies were finally included in this review. There were 15 controlled studies and 6 surgical series. Our one-arm meta-analysis demonstrated that the total PSM rates after intrafascial techniques ranging from 2.2 to 35%, with a pooled rate of 14.5% on average (480 of 3151 patients, 95% confidence interval[CI]: 11.2–17.5%). Meta-regression model showed that patients’ age, pT2 cancer percentage and Selection Score of Oncological Safety (SSOS) were significantly associated with total PSM rate; moreover, each 1 point of SSOS could decrease the total PSM rate by 1.3% on average. Comparative meta-analysis demonstrated that there was no significant difference between intra- and inter-fascial group regarding PSM rates.
Conclusions
With stringent case selection and when performed by experienced surgeons, intrafascial prostatectomy could offer an acceptable or, at least, equivalent PSM rate compared with the conventional interfascial approach. Preoperative SSOS more than 7 points could be considered as an indication of intrafascial radical prostatectomy.
Electronic supplementary material
The online version of this article (10.1186/s12894-019-0476-2) contains supplementary material, which is available to authorized users.
“…PSM rates of intrafascial group stratified by pathological tumor stages could be found in Additional files 2 and 3, which showed that the pooled PSM rate was 9.7% (236/2423, 95% CI: 7.0–12.4%) in pT2 cancers (Additional file 2: Figure S1) and 44.0% (208/527, 95% CI: 34.9–53.2%) in pT3 cancer (Additional file 3: Figure S2). Overlapping higher rates could be seen in terms of the PSM rate in pT2 cancer that the studies of Curto (2006) [11] and Mortezavi (2012) [16], which also reported a significantly higher PSM rate than the pooled rate; however, this overlap was not observed with regard to the PSM rate in pT3 cancer.Fig. 2Forest plot for one-arm meta-analysis of studies adopting the intrafascial technique in terms of total PSM rate in all-stage disease stratified by surgical types.…”
Section: Resultsmentioning
confidence: 95%
“…It was possible to calculate the heterogeneity among the included studies as I 2 was 86.38%. Three studies showed significantly higher PSM rates than the pooled rate, which included the studies of Curto 2006 [11], Choi 2012 [18], and Mortezavi 2012 [16], with a PSM rate of 30.8% (127/413, 95% CI: 26.3–35.2%), 34% (17/50, 95% CI: 20.9–47.1%), and 35% (28/80, 95% CI: 24.5–45.5%), respectively, whereas the VIP team reported a notably lower PSM rate of 1/46 [27]. No obvious differences could be detected among the 3 surgery types of LRP, RRP, and RALRP.…”
Background
Intrafascial prostatectomy was a modified technique from the conventional nerve-sparing surgery in order to improve patients’ post-surgical continence and erectile function; however, ongoing controversy exists regarding the oncological safety of this technique. In this study we aimed to provide a critical and pooled analysis based on published literatures regarding the oncological outcomes after intrafascial nerve-sparing prostatectomy.
Methods
Database searches were performed for published articles till June 2018 on PubMed. Three reviewers screened fulfilled papers and extracted data independently. Main outcome was the positive surgical margins (PSMs) rates stratified by pathological stages. We performed both one-arm and comparative meta-analysis to evaluate the oncological safety of intrafascial technique. Moreover, we built meta-regression models to assess the confounding factors.
Results
We retrieved a total of 117 records after electronic search, of which 21 studies were finally included in this review. There were 15 controlled studies and 6 surgical series. Our one-arm meta-analysis demonstrated that the total PSM rates after intrafascial techniques ranging from 2.2 to 35%, with a pooled rate of 14.5% on average (480 of 3151 patients, 95% confidence interval[CI]: 11.2–17.5%). Meta-regression model showed that patients’ age, pT2 cancer percentage and Selection Score of Oncological Safety (SSOS) were significantly associated with total PSM rate; moreover, each 1 point of SSOS could decrease the total PSM rate by 1.3% on average. Comparative meta-analysis demonstrated that there was no significant difference between intra- and inter-fascial group regarding PSM rates.
Conclusions
With stringent case selection and when performed by experienced surgeons, intrafascial prostatectomy could offer an acceptable or, at least, equivalent PSM rate compared with the conventional interfascial approach. Preoperative SSOS more than 7 points could be considered as an indication of intrafascial radical prostatectomy.
Electronic supplementary material
The online version of this article (10.1186/s12894-019-0476-2) contains supplementary material, which is available to authorized users.
“…This in turn results in maximizing the improvement of postoperative continence and potency rate without compromising the oncological efficacy 25 – 28 . Controversially, the IFRP nerve sparing technique might result in the increased rate of PSM and high biochemical recurrence risk 20 , 29 . This is the first systematic review and meta-analysis of all the currently available evidences regarding IFRP comparison with NIFRP.…”
Section: Discussionmentioning
confidence: 99%
“…Three studies demonstrated a higher rate of pT2 stage in IFRP group, but a higher rate of pT3 stage in NIFRP group. The reason for this could be attributed to an earlier preoperative clinical stage, lower PSA level and Gleason score selected for the IFRP patients in some studies 18 , 20 , 22 . Our meta-analysis study demonstrated a significantly higher BFS rate in IFRP group than NIFRP group at pT3 stage.…”
Section: Discussionmentioning
confidence: 99%
“…Ashkan Mortezavi et al . 20 reported that IFRP lead to a higher incidence of PSM. Wael Y Khoder et al .…”
In this meta-analysis study, we compared the oncological and functional outcomes of intrafascial radical prostatectomy (IFRP) with non-intrafascial radical prostatectomy (NIFRP) in the treatment of patients with low risk localized prostate cancer (PCa). Relevant articles were identified by searching PubMed, EMBASE, Cochrane Library, Ovid, and the ISI Web of Knowledge databases. A total of 2096 patients were included from 7 eligible studies. Results of the pooled data showed that the oncological outcomes including gleason score, positive surgical margin and biochemical free survival rates were similar between the two groups. IFRP was superior to NIFRP with lower postoperative complication rates (RR 0.57, 95% CI 0.38, 0.85, p = 0.006), higher continence rates at 3 months post-operation (RR: 1.14; 95% CI, 1.04, 1.26; p = 0.006), and higher potency rates at 6 months (RR: 1.53; 95% CI, 1.07, 2.18; p = 0.02) and 12 months post-operation (RR: 1.38; 95% CI, 1.11, 1.73; p = 0.005). Additionally, there was a tendency towards higher potency rate in patients ≤65 years old compared with patients >65 years old after IFRP. Overall, these findings suggest that IFRP in young patients with low risk localized PCa had less postoperative complications, shortened time to return to continence and improved potency rate without compromising complete tumor control.
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