The impact of nerve sparing on incidence and location of positive surgical margins in radical prostatectomy.

Abstract

•  To examine whether nerve-sparing surgery (NSS) is a risk factor for positive surgical margins (PSMs) in patients with either organ-confined prostate cancer or extracapsular extension (ECE). •  Clinicopathological outcome data on 945 consecutive patients treated with radical prostatectomy (RP) were prospectively collected. •  All patients underwent RP (bilateral, unilateral or non-NSS) by one surgeon between 2002 and 2007. •  Risk of PSMs and their locations with respect to NSS was determined by multivariate logistic regression analysis adjusting for preoperative risk factors for PSMs within pT2, pT3a and pT3b tumours. •  Overall a PSM was identified in 19.6% of patients in an unscreened population with mean prostate-specific antigen (PSA) level of 8.1 ng/mL. •  There was no significant difference in rates of PSMs between NSS groups on multivariate analysis (P= 0.147). •  There was no significant difference in pT2 (P= 0.880), pT3a (P= 0.175) or pT3b (P= 0.354) tumours. •  The only significant predictor of PSMs was preoperative PSA level (risk ratio 1.289, P= 0.006). •  There was no significant difference in the location of PSMs except for the pT3a group, where the patients that had bilateral NSS were at higher risk of a posterolateral PSM (P= 0.028). •  With appropriate selection of patients, NSS does not increase the risk of PSMs, whether the cancer is organ confined or ECE is present. •  The adverse impact of the NSS procedure in the hands of an experienced surgeon is minimal and is a realistic compromise to obtain the increase in health-related quality of life offered by NSS.