影響對機器人手臂根除性攝護腺手術前之3T mp-MRI有攝護腺包膜外侵犯之側別進行神經保留之因素
林冠榮1、黃逸修1,3,4、沈書慧2、黃奕燊1,3,4、林志杰1,3,4、林子平1,3,4、鍾孝仁1,3,4、盧星華1,3,4、黃志賢1,3,4、吳宏豪1,3,4、張延驊1,3,4、林登龍1,3,4
台北榮民總醫院 泌尿部1, 放射線部2 , 國立陽明大學醫學院 泌尿學科3, 書田泌尿科學研究中心4
The factors influencing the performance of nerve sparing technique on sides of extraprostatic extension on 3T mp-MRI prior to robotic assisted radical prostatectomy
Kuan-Jung Lin1, Eric YH Huang1,3,4, Shu-Huei Shen2, I-Shen Huang1,3,4, Chih-Cheh Lin1,3,4, Tzu-Ping Lin1,3,4, Hsiao-Jen Chung1,3,4, Shing-Hwa Lu1,3,4, William JS Huang1,3,4, Howard HH Wu1,3,4, Yen-Hwa Chang1,3,4, Alex TL Lin1,3,4
Department of Urology1 and Radiology2, Taipei Veterans General Hospital; School of Medicine2 and Shu-Tien Urological Institute3, National Yang-Ming University, Taiwan
Purpose:
Radical prostatectomy is the surgical treatment of choice for localized prostate cancer, which has shown favorable cancer control in patients with organ-confined disease. Multiparametric magnetic resonance imaging (mp-MRI) is a reasonable approach for surgical planning. We retrospectively reviewed the patients who received robotic-assisted radical prostatectomy (RARP) in our hospital to evaluate the impact of pre-operative mp-MRI on nerve-sparing technique and surgical margin.
Materials and Methods:
From 2010 to 2016, 230 patients with prostate cancer received 3T mp-MRI and robotic assisted radical prostatectomy were identified. The clinical data, PSA, Gleason score, MRI stage, extraprostatic extension(EPE) location on MRI, pathological stage, location of EPE, and positive surgical margin (PSM) status of pathology were retrospectively collected. The associations between EPE location on pre-operative mp-MRI and EPE/PSM on pathology were analyzed.
Results:
The mean age of the patients was 65.9 ± 6.2 (range 50-87). D’amico risk group was 28.3% in low risk, 40.4% in intermittent risk, and 31.3% in high risk. Pathological stage was 56.1% in T2 stage, 36.5% in T3a stage and 7.4% in T3b stage. EPE was noticed in 33.5% patients on 3T mp-MRI and 36.5% on final pathology. The factors influencing the PSM of RARP included small radiological prostate volume, higher Gleason score, higher MRI stage, and higher D’amico risk group. There were 82 sides (right or left side) of prostate suspected to have EPE on pre-operative MRI. Nerve-sparing was still performed in 41 (50.0%) of these sides. 9(22.0%) sides were found to have PSM on the same locations of EPE on mp-MRI. Nerve-sparing was not performed in the other 41 (50.0%) patients. PSM was noted in 12 (29.3%) sides on the same locations of EPE on mp-MRI. However, there was no significant difference of PSM rate in regards to the performance of nerve-sparing technique or not. (p=0.448) The factors influencing the decision making to perform nerve sparing technique on patients diagnosed as EPE on mp-MRI included younger age, less biopsy Gleason score, and less positive cores of TRUS biopsy. (Table) PSM rate for sides without EPE on pre-op mp-MRI was only 2.2% which was significantly lower than that of the counterpart.
Conclusion:
Whether to perform nerve-sparing technique in RARP or not in patients suspected to have EPE on pre-operative mp-MRI showed no difference in the final PSM rate. The factors influencing the decision making to perform nerve-sparing were younger age, less biopsy Gleason score, and less positive cores of TRUS biopsy.