The impact of nerve-sparing robotic-assisted radical prostatectomy on positive surgical margins: Uncertainty

Minimally invasive surgery for hepatocellular carcinoma

“…9 Additionally, incomplete resection and/or positive surgical margin (PSM) is always the key cause of the failure after treatment. 6,8,11 In the current study, 13 the difference of wideness of resection-free margin between RH and OH did not reach the statistical significance. The authors found the wideness of resection-free margin was less but recurrence rate was lower in the RH group than OH group.…”

“…13 The risk of reduced liver functional reserve after resection of HCC was reported nearly half of patients (47.7%). 5 A recent retrospective study in five high-volume centers in 2023 also supported the advantages of using RH in the management of HCC patients compared with OH, based on a significantly shorter hospital length of stay (median [IQR: interval of reference], 4 [3][4][5][6] days vs 10 [7-13] days), a lower number of admissions to the intensive care unit (7 [6.6%] vs 21 [19.8%]), and a lower incidence of posthepatectomy liver failure (8 [7.5%] vs 30 [28.3%]), with no cases of grade C failure, although a significantly longer operative time (median [IQR], 295 minutes vs 200 [165-255] minutes, including docking) was found in the RH group compared to OH. 16 Additionally, the survival rate was also better in the RH group, with the similar 90-day OS rate between the 2 groups (RH, 99.1% [95% CI, 93.5%-99.9%]; OH, 97.1% [95% CI, 91.3%-99.1%]), and a better trend of cumulative incidence of death related to tumor recurrence (RH, 8.8% [95% CI, 3.1%-18.3%]; OH, 10.2% [95% CI, 4.9%-17.7%]).…”

“…5 Similar to all other cancers, traditional surgery (exploratory laparotomy) and minimally invasive surgery (MIS: laparoscopy or robot) have been reported to be applicable for the aforementioned purpose, although some uncertainties are still in concerns if MIS is applied to many cancers. [6][7][8][9] It is well known that MIS may have taken many advantages, such as a better recovery, a better cosmetic need, and a shortening hospital stay (all are called a better quality of life [QoL]) compared with traditional surgery, some surgical oncologists still hesitate to receive the MIS as the choice of treatment for their patients because of much concern for the long-term oncological safety. 9,10 All need continuous studies to provide a better chance to prolong life span of diseased people and minimize the therapyrelated adverse events (AEs).…”

Nerve sparing robotic-assisted radical prostatectomy is not associated with an increased rate of positive surgical margins

“…We appreciate Dr. Yang’s very kind and immediate response 1 to our previous comments, 2 which have been published in the February issue of the Journal of the Chinese Medical Association about their original article in the last December issue of the Journal of the Chinese Medical Association entitled “Effects of nerve-sparing procedures on surgical margins after robot-assisted radical prostatectomy”. 3 As shown by the authors’ response, nerve-sparing robot-assisted radical prostatectomy (NS RARP) did not show a negative impact on the increased positive surgical margins (PSMs) rate using the multivariable analysis model; 1 however, we found that the odds ratio (OR) was less than 1 (0.825), suggesting that it is a trend that prostate cancer patients treated with NS RARP may have a lower risk of PSM than those treated with RARP group, although the difference of PSM between NS RARP and RARP groups did not reach a statistical significance (OR 0.825, 95% confidence interval 0.261-2.602).…”

“…We supposed the term of "lower" may be a "correct" description, and the description is consistent with the finding that OR is lower than 1. Based on our understanding of their article, 2 we do not think that NSRARP may increase the risk of PSM, and by contrast, the risk of PSM may be lower. For cancer treatment, besides the "curability of the diseases," the quality of life (QoL) has become one of the most important issues for patients.…”