Neurovascular structure-adjacent frozen-section examination robotic-assisted radical prostatectomy: outcomes from 500 consecutive cases in the UK

• Published in: Journal of robotic surgery 2022-08, Vol.16 (4), p.951-956
• Main Authors: Noël, Jonathan, Spencer, Neil H., Lodia, Siya, Karim, Seiver, Taneja, Surina, Moghanchizadeh, Darius, Nayak, Arvind, Tamhankar, Ashwin, Angra, Seema, Swamy, Rajiv, Agarwal, Samita, Narula, Ashish, Lane, Tim, Adshead, Jim, Vasdev, Nikhil
• Format: Article
• Language: English
• Subjects: Biopsy; Erectile dysfunction; Laparoscopy; Medicine; Medicine & Public Health; Minimally Invasive Surgery; Original Article; Paraffins; Pathology; Patients; Prostate cancer; Robotics; Surgeons; Surgery; Urological surgery; Urology
• ISSN: 1863-2491; 1863-2483; 1863-2491
• DOI: 10.1007/s11701-021-01324-2

The purpose is to report the United Kingdom’s largest single-centre experience of robotically assisted laparoscopic radical prostatectomies (RALP), using the neurovascular structure-adjacent frozen-section (NeuroSAFE) technique. We describe the utilisation and outcomes of this technique. This is a retrospective study from 2012 to 2019 on 520 patients undergoing NeuroSAFE RALP at our Institution. Our Institution’s database was analysed for false-positive frozen-section (FS) margins as confirmed on paraffin histopathological analysis: functional outcomes of potency, continence, and biochemical recurrence (BCR). The median (range) of console time was 145 (90–300) min. In our cohort, positive FS was seen in 30.7% (160/520) of patients, with a confirmatory paraffin analysis in 91.8% of our patients’ cohort (147/160). The neurovascular bundles (NVBs) that underwent secondary resection contained tumour in 26.8% (43/160) of the cases. Biochemical recurrence (BCR) was 6.7% (35/520), of which FS was positive in 40% (14/35) of those cases. There were insufficient evidence of a statistical association of urinary incontinence and positive surgical margin rates according to NS or NVB resection. NeuroSAFE enables intraoperative confirmation of the oncologic safety of a NS procedure. Patients with a positive FS on NeuroSAFE can be converted to a negative surgical margin (NSM) by ipsilateral wide resection. This spared 1 in 4 men from positive margins posterolaterally in our series. Limitations are the absence of a matched contemporary cohort of NS RALP without NeuroSAFE in our centre.