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Minerva Urologica e Nefrologica 2021 Jan 13

DOI: 10.23736/S0393-2249.20.04178-8


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 Luis MARENCO JIMÉNEZ 14, Dmitry ENIKEEV 1, 15, in collaboration with ESUT-YAUWP Group

1 Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; 2 Department of Urology, Institut 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 Young Academic Urologists, EAU, Netherlands; 7 Sechenov University, Moscow, Russia; 8 Department of Urology, La Paz University Hospital, Madrid, Spain; 9 Urology Department, University of Modena and Reggio Emilia, Modena, Italy; 10 Department of Urology, University of California, Irvine, CA, USA; 11 Department of Urology, Catherine & Joseph Aresty, USC Institute of Urology, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, Los Angeles, CA, USA; 12 Department of Radiology, Univ. of Southern California, Los Angeles, CA, USA; 13 Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy; 14 Hospital Universitario Virgen Macarena, Seville, Spain; 15 EAU Section on Uro-technology, Netherlands


BACKGROUND: We provide a systematic analysis of NSS to assess and summarize the risks and benefits of NSS in high-risk PCa.
METHODS: We have undertaken a systematic search of original articles at 3 databases (Medline (PubMed), Scopus, and Web of Science). Original articles in English containing outcomes of nerve-sparing 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: EF and urinary continence.
RESULTS: 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 OR for positive margin and biochemical relapse. The presented results showed no effect of NS on positive margin (OR=0.81, 0.6-1.09) or biochemical relapse (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 or 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; Prostate cancer; High oncological risk; Nerve-sparing

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