Peroperative histology during robotic-assisted radical prostatectomy with lymphadenectomy: a feasibility study
Authors:
Vladimír Študent ml. 1; Daniela Kurfürstová 2; Daniela Skanderová 2; Zuzana Seifriedová 1; Ondřej Česák 1; Hana Študentová 3; Dana Purová 1; Vladimír Študent 1
Authors‘ workplace:
Urologická klinika FN Olomouc a LF UP Olomouc
1; Ústav klinické a molekulární patologie FN Olomouc a LF UP Olomouc
2; Onkologická klinika FN Olomouc a LF UP Olomouc
3
Published in:
Ces Urol 2021; 25(3): 193-203
Category:
Original Articles
Overview
Introduction: Peroperative histology (IFS) during robot-assisted radical prostatectomy (RARP) is used to ensure better oncological outcomes of surgery and, thanks to the possibility of safer nervesparing surgery (NS), which could improve functional outcomes such as continence. and erection.
Aim: This work aims to develop our own IFS technique, verify its feasibility and describe its peroperative results in patients indicated for RARP with extended pelvic lymphadenectomy (ePLND).
Materials and methods: From September 2020 to May 2021, 21 RARPs with ePLNDs were performed with IFS (intervention group). The control group (n = 42) was selected from a database of patients with RARP with ePLND without IFS operated on between December 2019 and May 2021. The control group was assigned in a 2 : 1 ratio based on age, body mass index (BMI), and risk classification groups for biochemical recurrence (EAU risk groups). The IFS technique was developed, its reliability and effect on the length of the operation, the number of positive surgical margins (PSM), and the extended PSM (ePSM, defined as PSM in multiple locations or PSM one location with a length greater than 3 mm) were verified. In the case of a positive finding on IFS, periprostatic tissue resection was performed. Baseline and perioperative results were evaluated in both groups.
Results: The two groups did not differ in preoperative and pathological characteristics. The duration of surgery was longer in the intervention group (median 176 minutes, interquartile range – IQR 151–183 vs. 145 minutes, IQR 133–164, p = 0.0003). The time from specimen removal to reporting the IFS result was 55 minutes (median), IQR 52–64 minutes. The number of patients with a positive margin (PSM) was in the intervention group 6 (28,6%), while only three patients (14.3%) had an ePSM finding. In the control group, 18 patients with PSM were described (42%), while in 3 (7.1%), ePSM was found. Although the groups did not differ in the total number of PSM (p = 0.593), in the control group, there was a smaller number of patients with ePSM (p = 0.031). The degree of agreement of IFS with the definitive histopathological finding was 90.5%. The percentage of complete removal of the tumor by secondary resection was 28.6%.
Conslusion: We have demonstrated the feasibility of IFS in RARP with ePLND in the Czech healthcare system. IFS showed good agreement with the definitive histopathological evaluation. It is associated with longer operation time. IFS did not improve overall PSM in this cohort but contributed to complete tumor resection in one-third of PSM patients. This feasibility study helped to gain experience with IFS and led to the launch of another study with more patients.
Keywords:
prostate cancer – robot-assisted radical prostatectomy – nerve-sparing – neurosafe – peroperative histology – positive surgical margins
Sources
1. Costello AJ. Considering the role of radical prostatectomy in 21st century prostate cancer care. Nat Rev Urol 2020; 17(3): 177–188. doi:10.1038/s41585-020-0287-y.
2. Reeves F, Preece P, Kapoor J, et al. Preservation of the neurovascular bundles is associated with improved time to continence after radical prostatectomy but not long-term continence rates: Results of a systematic review and meta-analysis. Eur Urol 2015; 68(4): 692–704. doi: 10.1016/j.eururo.2014.10.020.
3. Michl U, Tennstedt P, Feldmeier L, et al. Nerve-sparing Surgery Technique, Not the Preservation of the Neurovascular Bundles, Leads to Improved Long-term Continence Rates After Radical Prostatectomy. Eur Urol 2016; 69(4): 584–589. doi: 10.1016/j.eururo.2015.07.037.
4. Tewari AK, Srivastava A, Huang MW, et al. Anatomical grades of nerve sparing: a risk-stratified approach to neural-hammock sparing during robot-assisted radical prostatectomy (RARP). BJU Int 2011; 108(6b): 984–992. doi: 10.1111/j.1464-410X.2011.10565.x
5. Rajan P, Hagman A, Sooriakumaran P, et al. Oncologic Outcomes After Robot-assisted Radical Prostatectomy: A Large European Single-centre Cohort with Median 10-Year Follow-up. Eur Urol Focus 2018; 4(3): 351–359. doi: 10.1016/j.euf.2016.10.007.
6. Dinneen E, Haider A, Grierson J, et al. NeuroSAFE frozen section during robot-assisted radical prostatectomy: peri-operative and histopathological outcomes from the NeuroSAFE PROOF feasibility randomized controlled trial. BJU Int 2021: bju.15256. doi: 10.1111/bju.15256.
7. Rocco B, Sighinolfi MC, Sandri M, et al. Is Extraprostatic Extension of Cancer Predictable? A Review of Predictive Tools and an External Validation Based on a Large and a Single Center Cohort of Prostate Cancer Patients. Urology 2019; 129: 8–20. doi: 10.1016/j.urology.2019.03.019.
8. de Rooij M, Hamoen EHJ, Witjes JA, et al. Accuracy of Magnetic Resonance Imaging for Local Staging of Prostate Cancer: A Diagnostic Meta-analysis. Eur Urol 2016; 70(2): 233–245. doi: 10.1016/j.eururo.2015.07.029.
9. Schlomm T, Tennstedt P, Huxhold C, et al. Neurovascular Structure-adjacent Frozen-section Examination (NeuroSAFE) Increases Nerve-sparing Frequency and Reduces Positive Surgical Margins in Open and Robot-assisted Laparoscopic Radical Prostatectomy : Experience After 11 069 Con 2012; 62: 333–340. doi: 2012.04.057.
10. Dinneen EP, Van Der Slot M, Adasonla K, et al. Intraoperative Frozen Section for Margin Evaluation During Radical Prostatectomy: A Systematic Review. Eur Urol Focus 2020; 6(4): 664–673. doi: 10.1016/j.euf.2019.11.009.
11. Preisser F, Theissen L, Wild P, et al. Implementation of Intraoperative Frozen Section During Radical Prostatectomy: Short-term Results from a German Tertiary-care Center. Eur Urol Focus 2021; 7(1): 95–101. doi: 10.1016/j.euf.2019.03.007.
12. Mottet N, Cornford P, van den Bergh RCN, et al. EAU-ESTRO-ESUR-SIOG Guidelines on prostate cancer. https://uroweb.org/guideline/prostate-cancer/. Accessed March 13, 2021.
13. Student V, Vidlar A, Grepl M, et al. Advanced Reconstruction of Vesicourethral Support (ARVUS) during Robot-assisted Radical Prostatectomy: One-year Functional Outcomes in a Two-group Randomised Controlled Trial. Eur Urol 2017; 71(5): 822–830. doi: 10.1016/j.eururo.2016.05.032.
14. Kumar A, Patel VR, Panaiyadiyan S, et al. Nerve-sparing robot-assisted radical prostatectomy: Current perspectives. Asian J Urol 2021; 8(1): 2–13. doi: 10.1016/j.ajur.2020.05.012.
15. Van Velthoven RF, Ahlering TE, Peltier A, et al. Technique for laparoscopic running urethrovesical anastomosis: The single knot method. Urology 2003; 61(4): 699–702. doi: 10.1016/S0090-4295(02)02543-8.
16. Koskas Y, Lannes F, Branger N, et al. Extent of positive surgical margins following radical prostatectomy: impact on biochemical recurrence with long-term follow-up. BMC Urol 2019; 19(1): 37. doi: 10.1186/ s12894-019-0470-8.
17. Beyer B, Schlomm T, Tennstedt P, et al. A Feasible and Time-efficient Adaptation of NeuroSAFE for da Vinci Robot-assisted Radical Prostatectomy. Eur Urol 2014; 66(1): 138–144. doi: 10.1016/j.eururo.2013.12.014.
18. Öbek C, Saglican Y, Ince U, et al. Intra-surgical total and re-constructible pathological prostate examination for safer margins and nerve preservation (Istanbul preserve). Ann Diagn Pathol 2018; 33: 35–39. doi: 10.1016/j.anndiagpath.2017.11.010.
19. Babjuk M, Příman O, Žemličková B, Veselý Š, Grega M. Role perioperační biopsie u robotické radikální prostatektomie pro karcinom prostaty. Studie proveditelnosti a krátkodobé výsledky. Ces Urol 2020; 24(Suppl. A): page 29.
20. Preisser F, Coxilha G, Heinze A, et al. Impact of positive surgical margin length and Gleason grade at the margin on biochemical recurrence in patients with organ-confined prostate cancer. Prostate 2019; 79(16): 1832–1836. doi: 10.1002/pros.23908.
21. Sooriakumaran P, Ploumidis A, Nyberg T, et al. The impact of length and location of positive margins in predicting biochemical recurrence after robot-assisted radical prostatectomy with a minimum follow-up of 5 years. BJU Int 2015; 115(1): 106–113. doi: 10.1111/bju.12483.
22. Hatzichristodoulou G, Wagenpfeil S, Weirich G, et al. Intraoperative frozen section monitoring during nerve-sparing radical prostatectomy: evaluation of partial secondary resection of neurovascular bundles and its effect on oncologic and functional outcome. World J Urol 2016; 34(2): 229–236. doi: 10.1007/ s00345-015-1623-3.
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Czech Urology
2021 Issue 3
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