Aims
Radical prostatectomy for prostate cancer is frequently complicated by urinary incontinence and erectile dysfunction. Nerve-sparing surgery reduces the risk of post-operative complications and can be optimized using intraoperative frozen sections of the adjacent neurovascular structure (NeuroSAFE). The aim of this study was to evaluate the pathological outcomes of the NeuroSAFE technique and to develop a comprehensive algorithm for intraoperative clinical decision-making.
Methods and results
Between September 2018 and May 2019, 491 NeuroSAFE procedures were performed in 258 patients undergoing radical prostatectomy; 74/491 (15.1%) NeuroSAFEs had a positive surgical margin. Compared to the corresponding paraffin sections, NeuroSAFE had a positive and negative predictive value of 85.1% and 95.4%, respectively. In 72.2% secondary neurovascular bundle resections prompted by a positive margin at NeuroSAFE, no tumour was present. These cases more often had a positive surgical margin of ≤1 mm (48.7% versus 20.0%; p=0.001) and only one positive slide (69.2% vs 33.3%; p=0.008). None of the nine patients with Gleason pattern 3 at the surgical margin, positive margin length ≤1 mm and one positive slide had tumour in the secondary resection.
Conclusions
This study provides a systematic reporting template for pathological intraoperative NeuroSAFE evaluation, supporting intraoperative clinical decision-making and comparison between prostate cancer operation centres.
