The impact of surgical approach (nerve bundle preservation versus wide local excision) on surgical margins and biochemical recurrence following radical prostatectomy

The Journal of Urology
John F WardMichael L Blute

Abstract

Surgical margin (SM) status is widely reported as a significant risk factor for prostate cancer recurrence following radical prostatectomy (RP). It has been presupposed that preserving the neurovascular bundle may compromise cancer control due to the limited surgical margin obtained with a resultant increase in treatment failure. We examined whether neurovascular bundle preservation during RP is a risk factor for positive SMs and progression-free survival after adjusting for disease severity. Outcomes following RP in 7,268 men between 1990 and 2000 were examined retrospectively. Median followup in those last known to be alive is 6.4 years. RP was performed by a total of 21 surgeons in the same basic fashion with strict attention to anatomical detail. Overall a positive SM was identified in 38% of patients. The positive SM rate was higher for wide excision than for nerve sparing (NS) (42% vs 34%) (p </= 0.001). The OR for positive SMs in patients undergoing NS-RP was 0.86 (95% CI 0.76 to 0.97, p = 0.012) after incorporating age, clinical stage, biopsy grade, year of surgery and prostate specific antigen. Similarly NS-RP had no significant impact on biochemical progression rates after controlling for these variables (HR 0.98, 95%...Continue Reading

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