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Minerva Urology and Nephrology 2021 June;73(3):283-91

DOI: 10.23736/S2724-6051.20.04178-8


lingua: Inglese

A systematic review of nerve-sparing surgery for high-risk prostate cancer

Andrey MOROZOV 1, Eric BARRET 2, Domenico VENEZIANO 3, 4, Vagarshak GRIGORYAN 1, Georg SALOMON 5, Igor FOKIN 1, Mark TARATKIN 1, 6 , Elena PODDUBSKAYA 7, Juan GOMEZ RIVAS 8, Stefano PULIATTI 9, Zhamshid OKHUNOV 10, Giovanni E. CACCIAMANI 11, 12, Enrico CHECCUCCI 13, José L. MARENCO JIMÉNEZ 14, Dmitry ENIKEEV 1, 15, ESUT-YAUWP Group

1 Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; 2 Department of Urology, Institute Mutualiste Montsouris, Paris, France; 3 Department of Urology and Kidney Transplant, G.O.M. Reggio Calabria, Reggio Calabria, Italy; 4 Hofstra University, New York, NY, USA; 5 Martini Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; 6 European Association of Urology (EAU), Arnhem, the Netherlands; 7 Sechenov University, Moscow, Russia; 8 Department of Urology, La Paz University Hospital, Madrid, Spain; 9 Department of Urology, University of Modena and Reggio Emilia, Modena, Italy; 10 Department of Urology, University of California, Irvine, CA, USA; 11 Keck School of Medicine, Department of Urology, Catherine & Joseph Aresty Foundation, USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, CA, USA; 12 Department of Radiology, University of Southern California, Los Angeles, CA, USA; 13 School of Medicine, Division of Urology, Department of Oncology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy; 14 Virgen Macarena University Hospital, Seville, Spain; 15 Section of Urotechnology, European Association of Urology (EAU), Arnhem, the Netherlands

INTRODUCTION: We provide a systematic analysis of nerve-sparing surgery (NSS) to assess and summarize the risks and benefits of NSS in high-risk prostate cancer (PCa).
EVIDENCE ACQUISITION: We have undertaken a systematic search of original articles using 3 databases: Medline/PubMed, Scopus, and Web of Science. Original articles in English containing outcomes of nerve-sparing radical prostatectomy (RP) for high-risk PCa were included. The primary outcomes were oncological results: the rate of positive surgical margins and biochemical relapse. The secondary outcomes were functional results: erectile function (EF) and urinary continence.
EVIDENCE SYNTHESIS: The rate of positive surgical margins differed considerably, from zero to 47%. The majority of authors found no correlation between NSS and a positive surgical margin rate. The rate of biochemical relapse ranged from 9.3% to 61%. Most of the articles lacked data on odds ratio (OR) for positive margin and biochemical relapse. The presented results showed no effect of nerve sparing (NS) on positive margin (OR=0.81, 0.6-1.09) or biochemical relapse (hazard ratio [HR]=0.93, 0.52-1.64). A strong association between NSS and potency rate was observed. Without NSS, between 0% and 42% of patients were potent, with unilateral 79-80%, with bilateral - up to 90-100%. Urinary continence was not strongly associated with NSS and was relatively good in both patients with and without NSS.
CONCLUSIONS: NSS may provide benefits for patients with urinary continence and significantly improves EF in high-risk patients. Moreover, it is not associated with an increased risk of relapse in short- and middle-term follow-up. However, the advantages of using such a surgical technique are unclear.

KEY WORDS: Systematic review; Prostatic neoplasms; Surgical procedures, operative

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