The NeuroSAFE technique for the pathologic examination of prostatic tissue adjacent to the neurovascular bundle during radical prostatectomy enables more men to undergo nerve-sparing surgery (NSS) for prostate cancer, according to a recent report in BJU International.
The technique was developed at the Martini-Klinik at University Hospital Hamburg-Eppendorf in Germany. As the authors explained the technique in the report, a surgeon removes prostatic tissue adjacent to the neurovascular bundles from apex to base bilaterally after removal of the prostate. The tissue is then submitted to the pathology department for intra-operative frozen-section assessment. During this time, the surgeon performs hemostasis, vesicourethral anastomosis preparation, and pelvic lymph node dissection if indicated. No further resection is performed if the surgical margin is negative.
Margaretha A. van der Slot, MD, of the Anser Prostate Operation Clinic at Maasstad Hospital in Rotterdam, The Netherlands, and colleagues studied 1756 patients who underwent robotic-assisted radical prostatectomy for prostate cancer, of whom 959 (55%) underwent the procedure with NeuroSAFE from September 2018 to December 2020 and 797 (45%) had the procedure without NeuroSAFE (control cohort) from January 2016 to September 2018.
Compared with the control group, the NeuroSAFE recipients had significant 3.9- and 5.2-fold increased odds of unilateral and bilateral nerve-sparing surgery, respectively. NeuroSAFE had the strongest impact among patients with pT3 disease. In these patients, 82.8% of the NeuroSAFE group had NSS compared with 54.8% of the control group, according to the investigators.
In addition, patients in the NeuroSAFE group had a significant 38% lower risk for biochemical recurrence (BCR) compared with the control arm.
In the entire cohort, NeuroSAFE did not independently predict positive surgical margin status.
Patients in the NeuroSAFE group were significantly older than those in the control arm (median 68 vs 66 years) and they were more likely to have cT3 disease (13.5% vs 5.0%).
The investigators acknowledged that their study was limited by use of a historical cohort for comparison and lack of functional outcomes.
Van der Slot MA, den Bakker MA, Tan TSC, et al. NeuroSAFE in radical prostatectomy increases the rate of nerve-sparing surgery without affecting oncological outcome. BJU Int. Published online May 10, 2022. doi:10.1111/bju.15771