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Reality of nerve sparing and surgical margins in surgeons’ early experience with robot‐assisted radical prostatectomy in Japan
Objective To analyze nerve sparing performance at an early stage of robot‐assisted radical prostatectomy, and the correlation between the surgeons’ experience and the risk of a positive surgical margin in patients treated with robot‐assisted radical prostatectomy. Methods Patients’ records from Janu...
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| Published in: | International journal of urology 2017-03, Vol.24 (3), p.191-196 |
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| container_issue | 3 |
| container_start_page | 191 |
| container_title | International journal of urology |
| container_volume | 24 |
| creator | Tatsugami, Katsunori Yoshioka, Kunihiko Shiroki, Ryoichi Eto, Masatoshi Yoshino, Yasushi Tozawa, Keiichi Fukasawa, Satoshi Fujisawa, Masato Takenaka, Atsushi Nasu, Yasutomo Kashiwagi, Akira Gotoh, Momokazu Terachi, Toshiro |
| description | Objective
To analyze nerve sparing performance at an early stage of robot‐assisted radical prostatectomy, and the correlation between the surgeons’ experience and the risk of a positive surgical margin in patients treated with robot‐assisted radical prostatectomy.
Methods
Patients’ records from January 2009 to March 2013 were retrospectively reviewed, and 3469 patients with localized prostate cancer were identified at 45 institutions. Individual surgeon's experience with nerve sparing was recorded as the number of nerve sparing cases among total robot‐assisted radical prostatectomies beginning with the first case during which nerve sparing was carried out. Patients were selected by propensity score matching for nerve sparing, and predictive factors of positive surgical margins were analyzed in patients with and without positive surgical margins.
Results
A total of 152 surgeons were studied, and the median number of robot‐assisted radical prostatectomy cases for all surgeons was 21 (range 1–511). In all, 54 surgeons (35.5%) undertook nerve sparing during their first robot‐assisted radical prostatectomy case. For 2388 patients selected with (1194) and without (1194) nerve sparing, predictive factors for positive surgical margin were high initial prostate‐specific antigen level (P |
| doi_str_mv | 10.1111/iju.13281 |
| format | article |
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To analyze nerve sparing performance at an early stage of robot‐assisted radical prostatectomy, and the correlation between the surgeons’ experience and the risk of a positive surgical margin in patients treated with robot‐assisted radical prostatectomy.
Methods
Patients’ records from January 2009 to March 2013 were retrospectively reviewed, and 3469 patients with localized prostate cancer were identified at 45 institutions. Individual surgeon's experience with nerve sparing was recorded as the number of nerve sparing cases among total robot‐assisted radical prostatectomies beginning with the first case during which nerve sparing was carried out. Patients were selected by propensity score matching for nerve sparing, and predictive factors of positive surgical margins were analyzed in patients with and without positive surgical margins.
Results
A total of 152 surgeons were studied, and the median number of robot‐assisted radical prostatectomy cases for all surgeons was 21 (range 1–511). In all, 54 surgeons (35.5%) undertook nerve sparing during their first robot‐assisted radical prostatectomy case. For 2388 patients selected with (1194) and without (1194) nerve sparing, predictive factors for positive surgical margin were high initial prostate‐specific antigen level (P < 0.0001), high biopsy Gleason score (P = 0.0379), presence of neoadjuvant hormone therapy (P = 0.0002) and surgeon's experience with >100 cases (P = 0.0058). Thus, nerve sparing was not associated with positive surgical margins.
Conclusion
The surgeon's experience influences the occurrence of positive surgical margins, although a considerable number of surgeons carried out nerve sparing during their early robot‐assisted radical prostatectomy cases. Surgeons should consider their own experience and prostate cancer characteristics before carrying out a nerve sparing robot‐assisted radical prostatectomy.</description><identifier>ISSN: 0919-8172</identifier><identifier>EISSN: 1442-2042</identifier><identifier>DOI: 10.1111/iju.13281</identifier><identifier>PMID: 28122393</identifier><language>eng</language><publisher>Australia: Wiley Subscription Services, Inc</publisher><subject>Aged ; Biopsy ; Cancer surgery ; Clinical Competence - statistics & numerical data ; Early experience ; Humans ; Japan ; Logistic Models ; Male ; Margins of Excision ; Middle Aged ; Multivariate Analysis ; Neoplasm Grading ; nerve sparing ; Organ Sparing Treatments ; Propensity Score ; Prostate - innervation ; Prostate - surgery ; Prostate cancer ; Prostate-specific antigen ; Prostatectomy ; Prostatic Neoplasms - surgery ; Retrospective Studies ; Robotic surgery ; Robotic Surgical Procedures ; robotics ; Robots ; Surgeons ; surgical margin ; Trauma, Nervous System - prevention & control</subject><ispartof>International journal of urology, 2017-03, Vol.24 (3), p.191-196</ispartof><rights>2017 The Japanese Urological Association</rights><rights>2017 The Japanese Urological Association.</rights><rights>Copyright © 2017 The Japanese Urological Association</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4451-4364a805a02d52cfa1db4002f4512c3efc8f1b5bb04426324d295fcbc874958a3</citedby><cites>FETCH-LOGICAL-c4451-4364a805a02d52cfa1db4002f4512c3efc8f1b5bb04426324d295fcbc874958a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27922,27923</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28122393$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tatsugami, Katsunori</creatorcontrib><creatorcontrib>Yoshioka, Kunihiko</creatorcontrib><creatorcontrib>Shiroki, Ryoichi</creatorcontrib><creatorcontrib>Eto, Masatoshi</creatorcontrib><creatorcontrib>Yoshino, Yasushi</creatorcontrib><creatorcontrib>Tozawa, Keiichi</creatorcontrib><creatorcontrib>Fukasawa, Satoshi</creatorcontrib><creatorcontrib>Fujisawa, Masato</creatorcontrib><creatorcontrib>Takenaka, Atsushi</creatorcontrib><creatorcontrib>Nasu, Yasutomo</creatorcontrib><creatorcontrib>Kashiwagi, Akira</creatorcontrib><creatorcontrib>Gotoh, Momokazu</creatorcontrib><creatorcontrib>Terachi, Toshiro</creatorcontrib><creatorcontrib>Japanese Society of Endourology</creatorcontrib><creatorcontrib>the Japanese Society of Endourology</creatorcontrib><title>Reality of nerve sparing and surgical margins in surgeons’ early experience with robot‐assisted radical prostatectomy in Japan</title><title>International journal of urology</title><addtitle>Int J Urol</addtitle><description>Objective
To analyze nerve sparing performance at an early stage of robot‐assisted radical prostatectomy, and the correlation between the surgeons’ experience and the risk of a positive surgical margin in patients treated with robot‐assisted radical prostatectomy.
Methods
Patients’ records from January 2009 to March 2013 were retrospectively reviewed, and 3469 patients with localized prostate cancer were identified at 45 institutions. Individual surgeon's experience with nerve sparing was recorded as the number of nerve sparing cases among total robot‐assisted radical prostatectomies beginning with the first case during which nerve sparing was carried out. Patients were selected by propensity score matching for nerve sparing, and predictive factors of positive surgical margins were analyzed in patients with and without positive surgical margins.
Results
A total of 152 surgeons were studied, and the median number of robot‐assisted radical prostatectomy cases for all surgeons was 21 (range 1–511). In all, 54 surgeons (35.5%) undertook nerve sparing during their first robot‐assisted radical prostatectomy case. For 2388 patients selected with (1194) and without (1194) nerve sparing, predictive factors for positive surgical margin were high initial prostate‐specific antigen level (P < 0.0001), high biopsy Gleason score (P = 0.0379), presence of neoadjuvant hormone therapy (P = 0.0002) and surgeon's experience with >100 cases (P = 0.0058). Thus, nerve sparing was not associated with positive surgical margins.
Conclusion
The surgeon's experience influences the occurrence of positive surgical margins, although a considerable number of surgeons carried out nerve sparing during their early robot‐assisted radical prostatectomy cases. Surgeons should consider their own experience and prostate cancer characteristics before carrying out a nerve sparing robot‐assisted radical prostatectomy.</description><subject>Aged</subject><subject>Biopsy</subject><subject>Cancer surgery</subject><subject>Clinical Competence - statistics & numerical data</subject><subject>Early experience</subject><subject>Humans</subject><subject>Japan</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Margins of Excision</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Neoplasm Grading</subject><subject>nerve sparing</subject><subject>Organ Sparing Treatments</subject><subject>Propensity Score</subject><subject>Prostate - innervation</subject><subject>Prostate - surgery</subject><subject>Prostate cancer</subject><subject>Prostate-specific antigen</subject><subject>Prostatectomy</subject><subject>Prostatic Neoplasms - surgery</subject><subject>Retrospective Studies</subject><subject>Robotic surgery</subject><subject>Robotic Surgical Procedures</subject><subject>robotics</subject><subject>Robots</subject><subject>Surgeons</subject><subject>surgical margin</subject><subject>Trauma, Nervous System - prevention & control</subject><issn>0919-8172</issn><issn>1442-2042</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><recordid>eNqNkcFqFTEUhoMo9lpd-AIScKOLaZNMcptZykVtS0EQuw5nMmfaXOZmxmSmdXbFJ3Dr6_VJenpv7UIQzCYh-fg4-X_GXktxIGkdhvV0IEtl5RO2kFqrQgmtnrKFqGRVWHmk9tiLnNdCECTtc7ZHqFJlVS7Yz68IXRhn3rc8YrpCngdIIV5wiA3PU7oIHjq-ATrEzEPc3mEf8-3Nb46QupnjjwFTwOiRX4fxkqe-7sfbm1-Qc8gjNjxBs7UMqc8jjOjHfjPfu05hgPiSPWuhy_jqYd9n558-flsdF2dfPp-sPpwVXmsjC10uNVhhQKjGKN-CbGothGrpUfkSW29bWZu6FpTAslS6UZVpfe3tka6MhXKfvdt5aYzvE-bRbUL22HUQsZ-yk5aiMlJo-x_oUilrdKUJffsXuu6nFOkjTlbUA1GlIer9jvIUQU7YuiEFCnV2Urj7Dh116LYdEvvmwTjVG2weyT-lEXC4A65Dh_O_Te7k9HynvAOnQ6hu</recordid><startdate>201703</startdate><enddate>201703</enddate><creator>Tatsugami, Katsunori</creator><creator>Yoshioka, Kunihiko</creator><creator>Shiroki, Ryoichi</creator><creator>Eto, Masatoshi</creator><creator>Yoshino, Yasushi</creator><creator>Tozawa, Keiichi</creator><creator>Fukasawa, Satoshi</creator><creator>Fujisawa, Masato</creator><creator>Takenaka, Atsushi</creator><creator>Nasu, Yasutomo</creator><creator>Kashiwagi, Akira</creator><creator>Gotoh, Momokazu</creator><creator>Terachi, Toshiro</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7X8</scope></search><sort><creationdate>201703</creationdate><title>Reality of nerve sparing and surgical margins in surgeons’ early experience with robot‐assisted radical prostatectomy in Japan</title><author>Tatsugami, Katsunori ; Yoshioka, Kunihiko ; Shiroki, Ryoichi ; Eto, Masatoshi ; Yoshino, Yasushi ; Tozawa, Keiichi ; Fukasawa, Satoshi ; Fujisawa, Masato ; Takenaka, Atsushi ; Nasu, Yasutomo ; Kashiwagi, Akira ; Gotoh, Momokazu ; Terachi, Toshiro</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4451-4364a805a02d52cfa1db4002f4512c3efc8f1b5bb04426324d295fcbc874958a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Biopsy</topic><topic>Cancer surgery</topic><topic>Clinical Competence - statistics & numerical data</topic><topic>Early experience</topic><topic>Humans</topic><topic>Japan</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Margins of Excision</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Neoplasm Grading</topic><topic>nerve sparing</topic><topic>Organ Sparing Treatments</topic><topic>Propensity Score</topic><topic>Prostate - innervation</topic><topic>Prostate - surgery</topic><topic>Prostate cancer</topic><topic>Prostate-specific antigen</topic><topic>Prostatectomy</topic><topic>Prostatic Neoplasms - surgery</topic><topic>Retrospective Studies</topic><topic>Robotic surgery</topic><topic>Robotic Surgical Procedures</topic><topic>robotics</topic><topic>Robots</topic><topic>Surgeons</topic><topic>surgical margin</topic><topic>Trauma, Nervous System - prevention & control</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tatsugami, Katsunori</creatorcontrib><creatorcontrib>Yoshioka, Kunihiko</creatorcontrib><creatorcontrib>Shiroki, Ryoichi</creatorcontrib><creatorcontrib>Eto, Masatoshi</creatorcontrib><creatorcontrib>Yoshino, Yasushi</creatorcontrib><creatorcontrib>Tozawa, Keiichi</creatorcontrib><creatorcontrib>Fukasawa, Satoshi</creatorcontrib><creatorcontrib>Fujisawa, Masato</creatorcontrib><creatorcontrib>Takenaka, Atsushi</creatorcontrib><creatorcontrib>Nasu, Yasutomo</creatorcontrib><creatorcontrib>Kashiwagi, Akira</creatorcontrib><creatorcontrib>Gotoh, Momokazu</creatorcontrib><creatorcontrib>Terachi, Toshiro</creatorcontrib><creatorcontrib>Japanese Society of Endourology</creatorcontrib><creatorcontrib>the Japanese Society of Endourology</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of urology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tatsugami, Katsunori</au><au>Yoshioka, Kunihiko</au><au>Shiroki, Ryoichi</au><au>Eto, Masatoshi</au><au>Yoshino, Yasushi</au><au>Tozawa, Keiichi</au><au>Fukasawa, Satoshi</au><au>Fujisawa, Masato</au><au>Takenaka, Atsushi</au><au>Nasu, Yasutomo</au><au>Kashiwagi, Akira</au><au>Gotoh, Momokazu</au><au>Terachi, Toshiro</au><aucorp>Japanese Society of Endourology</aucorp><aucorp>the Japanese Society of Endourology</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Reality of nerve sparing and surgical margins in surgeons’ early experience with robot‐assisted radical prostatectomy in Japan</atitle><jtitle>International journal of urology</jtitle><addtitle>Int J Urol</addtitle><date>2017-03</date><risdate>2017</risdate><volume>24</volume><issue>3</issue><spage>191</spage><epage>196</epage><pages>191-196</pages><issn>0919-8172</issn><eissn>1442-2042</eissn><abstract>Objective
To analyze nerve sparing performance at an early stage of robot‐assisted radical prostatectomy, and the correlation between the surgeons’ experience and the risk of a positive surgical margin in patients treated with robot‐assisted radical prostatectomy.
Methods
Patients’ records from January 2009 to March 2013 were retrospectively reviewed, and 3469 patients with localized prostate cancer were identified at 45 institutions. Individual surgeon's experience with nerve sparing was recorded as the number of nerve sparing cases among total robot‐assisted radical prostatectomies beginning with the first case during which nerve sparing was carried out. Patients were selected by propensity score matching for nerve sparing, and predictive factors of positive surgical margins were analyzed in patients with and without positive surgical margins.
Results
A total of 152 surgeons were studied, and the median number of robot‐assisted radical prostatectomy cases for all surgeons was 21 (range 1–511). In all, 54 surgeons (35.5%) undertook nerve sparing during their first robot‐assisted radical prostatectomy case. For 2388 patients selected with (1194) and without (1194) nerve sparing, predictive factors for positive surgical margin were high initial prostate‐specific antigen level (P < 0.0001), high biopsy Gleason score (P = 0.0379), presence of neoadjuvant hormone therapy (P = 0.0002) and surgeon's experience with >100 cases (P = 0.0058). Thus, nerve sparing was not associated with positive surgical margins.
Conclusion
The surgeon's experience influences the occurrence of positive surgical margins, although a considerable number of surgeons carried out nerve sparing during their early robot‐assisted radical prostatectomy cases. Surgeons should consider their own experience and prostate cancer characteristics before carrying out a nerve sparing robot‐assisted radical prostatectomy.</abstract><cop>Australia</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28122393</pmid><doi>10.1111/iju.13281</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 0919-8172 |
| ispartof | International journal of urology, 2017-03, Vol.24 (3), p.191-196 |
| issn | 0919-8172 1442-2042 |
| language | eng |
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| source | Wiley:Jisc Collections:Wiley Read and Publish Open Access 2024-2025 (reading list) |
| subjects | Aged Biopsy Cancer surgery Clinical Competence - statistics & numerical data Early experience Humans Japan Logistic Models Male Margins of Excision Middle Aged Multivariate Analysis Neoplasm Grading nerve sparing Organ Sparing Treatments Propensity Score Prostate - innervation Prostate - surgery Prostate cancer Prostate-specific antigen Prostatectomy Prostatic Neoplasms - surgery Retrospective Studies Robotic surgery Robotic Surgical Procedures robotics Robots Surgeons surgical margin Trauma, Nervous System - prevention & control |
| title | Reality of nerve sparing and surgical margins in surgeons’ early experience with robot‐assisted radical prostatectomy in Japan |
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