Centralized prostatectomy with intraoperative NeuroSAFE margin assessment improves surgical margin control.

Area of Science:

• Urology
• Surgical Oncology
• Pathology

Background:

• Robot-assisted radical prostatectomy (RARP) is a standard treatment for prostate cancer.
• Achieving negative surgical margins (NSM) is crucial for optimal patient outcomes.
• Intraoperative frozen-section analysis can help identify positive surgical margins (PSM) during surgery.

Purpose of the Study:

• To compare surgical margin status in prostate cancer patients undergoing RARP with and without intraoperative neurovascular structure-adjacent frozen-section analysis (NeuroSAFE).
• To evaluate the impact of NeuroSAFE on positive surgical margin (PSM) rates and lengths.

Main Methods:

• A retrospective analysis compared 962 patients who underwent RARP with NeuroSAFE (centralized cohort) to 835 patients who underwent RARP without NeuroSAFE (tertiary center cohort).
• Multivariable logistic regression controlled for clinicopathological variables to assess differences in PSM risk.
• Secondary resections were performed for PSM identified by intraoperative frozen section (IFS) analysis.

Main Results:

• The NeuroSAFE cohort showed a 29% PSM rate, with a median cumulative PSM length of 1.1 mm.
• After adjusting for covariates, patients treated with NeuroSAFE had significantly lower odds of PSM (OR: 0.70) compared to those without.
• NeuroSAFE was associated with substantially reduced odds of PSM length >1 mm (OR: 0.14) and >3 mm (OR: 0.21).

Conclusions:

• Centralization of RARP with NeuroSAFE is associated with improved surgical margin control.
• NeuroSAFE significantly reduces both the rate and cumulative length of positive surgical margins in prostate cancer patients.
• This technique enhances the ability to achieve negative surgical margins, potentially improving oncological outcomes.