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Review
. 2019 May 27;19(1):41.
doi: 10.1186/s12894-019-0476-2.

Oncological safety of intrafascial nerve-sparing radical prostatectomy compared with conventional process: a pooled review and meta-regression analysis based on available studies

Xiao Wang  1 , Yiqi Wu  1 , Jia Guo  1 , Hui Chen  1 , Xiaodong Weng  1 , Xiuheng Liu  2
Affiliations
Review

Oncological safety of intrafascial nerve-sparing radical prostatectomy compared with conventional process: a pooled review and meta-regression analysis based on available studies

Xiao Wang et al. BMC Urol. .

Abstract

Background: Intrafascial prostatectomy was a modified technique from the conventional nerve-sparing surgery in order to improve patients' post-surgical continence and erectile function; however, ongoing controversy exists regarding the oncological safety of this technique. In this study we aimed to provide a critical and pooled analysis based on published literatures regarding the oncological outcomes after intrafascial nerve-sparing prostatectomy.

Methods: Database searches were performed for published articles till June 2018 on PubMed. Three reviewers screened fulfilled papers and extracted data independently. Main outcome was the positive surgical margins (PSMs) rates stratified by pathological stages. We performed both one-arm and comparative meta-analysis to evaluate the oncological safety of intrafascial technique. Moreover, we built meta-regression models to assess the confounding factors.

Results: We retrieved a total of 117 records after electronic search, of which 21 studies were finally included in this review. There were 15 controlled studies and 6 surgical series. Our one-arm meta-analysis demonstrated that the total PSM rates after intrafascial techniques ranging from 2.2 to 35%, with a pooled rate of 14.5% on average (480 of 3151 patients, 95% confidence interval[CI]: 11.2-17.5%). Meta-regression model showed that patients' age, pT2 cancer percentage and Selection Score of Oncological Safety (SSOS) were significantly associated with total PSM rate; moreover, each 1 point of SSOS could decrease the total PSM rate by 1.3% on average. Comparative meta-analysis demonstrated that there was no significant difference between intra- and inter-fascial group regarding PSM rates.

Conclusions: With stringent case selection and when performed by experienced surgeons, intrafascial prostatectomy could offer an acceptable or, at least, equivalent PSM rate compared with the conventional interfascial approach. Preoperative SSOS more than 7 points could be considered as an indication of intrafascial radical prostatectomy.

Keywords: Intrafascial nerve-sparing; Oncological safety; Positive surgical margins; Radical prostatectomy; Systematic review.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flowchart for identification and selection of studies for this systematic review
Fig. 2
Fig. 2
Forest plot for one-arm meta-analysis of studies adopting the intrafascial technique in terms of total PSM rate in all-stage disease stratified by surgical types. PSM, positive surgical margin; LRP, laparoscopic radical prostatectomy; RRP, retropubic radical prostatectomy; RALRP, robot-assisted laparoscopic radical prostatectomy; VIP, Vattikuti Institute Prostatectomy
Fig. 3
Fig. 3
Influence of (a) age, (b) pT2 cancer percentage, and (c) the Selection Score of Oncologic Safety on total PSM rate in all-stage cancer following intrafascial radical prostatectomy. PSM, positive surgical margin
Fig. 4
Fig. 4
Forest plots for comparative meta-analysis of studies comparing the intrafascial with the interfascial technique in terms of the total PSM rate in all-stage cancer stratified by whether selection balance was achieved. PSM, positive surgical margin; VIP, Vattikuti Institute Prostatectomy
Fig. 5
Fig. 5
Forest plots for comparative meta-analysis of studies comparing the intrafascial with interfascial technique in terms of (a) PSM rate for pT2 cancer and (b) PSM rate for pT3 cancer stratified by whether selection balance was achieved. PSM, positive surgical margin
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References

    1. Walsh PC. Radical prostatectomy for localized prostate cancer provides durable cancer control with excellent quality of life: a structured debate. J Urol. 2000;163(6):1802–1807. doi: 10.1016/S0022-5347(05)67547-7. - DOI - PubMed
    1. Han M, Partin AW, Pound CR, Epstein JI, Walsh PC. Long-term biochemical disease-free and cancer-specific survival following anatomic radical retropubic prostatectomy. The 15-year Johns Hopkins experience. Urol Clin North Am. 2001;28(3):555–565. doi: 10.1016/S0094-0143(05)70163-4. - DOI - PubMed
    1. Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, De Santis M, et al. EAU-ESTRO-SIOG guidelines on prostate Cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol. 2017;71(4):618–629. doi: 10.1016/j.eururo.2016.08.003. - DOI - PubMed
    1. Costello AJ, Brooks M, Cole OJ. Anatomical studies of the neurovascular bundle and cavernosal nerves. BJU Int. 2004;94(7):1071–1076. doi: 10.1111/j.1464-410X.2004.05106.x. - DOI - PubMed
    1. Stolzenburg JU, Rabenalt R, Tannapfel A, Liatsikos EN. Intrafascial nerve-sparing endoscopic extraperitoneal radical prostatectomy. Urology. 2006;67(1):17–21. doi: 10.1016/j.urology.2005.09.052. - DOI - PubMed