Prospective comparison of one year follow-up outcomes for the open complete intrafascial retropubic versus interfascial nerve-sparing radical prostatectomy

Abstract

Current work provides a prospective direct comparison between Open complete intrafascial-radical-prostatectomy (OIF-RP) and interfascial-RP in all outcomes in single centre series. Both techniques were done prospectively in 430 patients. Inclusion criteria for OIF-RP (n=241 patients) were biopsy Gleason-score ≤6 and PSA ≤10 ng/ml while for interfascial-RP (n=189) were Gleason-score ≤7 and PSA ≤15. The perioperative parameters (e.g. operative time, complications etc.), pathologic results, surgical margins and revisions were reviewed. Pre- and postoperative (3 and 12 months) evaluation of continence and potency was performed. All patients have preoperative IIEF-score of ≥15. Continence was classified as complete (no pads), mild (1-2 pads/day) and incontinence (>2 pads/day). Median patients’ age was 63.7 vs. 64.5 years for OIF-RP vs. Interfascial-RP, respectively. Preoperative PSA-level was significantly lower in OIF-RP (5.8 vs. 7.1), otherwise, similar perioperative data in both groups except for more frequent pT3-tumors in interfascial-RP group (18%). No statistical significance regarding continence was observed between OIF-RP vs. Interfascial-RP groups at 3 (82% vs. 85%) and 12 months (98% vs. 96%) postoperatively. Potency rates (IIEF ≥15) after OIF-RP were 96% (≤55 years), 72% (55-65), and 75% (>65 years) at 12 months. The respective rates for interfascial-group were 58%, 61% and 51%. There was an advantage for OIF-RP potency-outcomes without significance over Interfascial-RP in weak potency patients (IIEF=15-18). We conclude that OIF-RP is associated with better functional results without compromising early oncological results compared to interfascial-RP. Complete preservation of periprostatic fasciae provides significantly better postoperative recovery of sexual function even for weak potency patients. Longer follow-up is mandatory to further evaluate the outcome results of this technique.

Intrafascial versus interfascial nerve sparing in radical prostatectomy for localized prostate cancer: a systematic review and meta-analysis

“…These six comparative trials included one RCT 7 , three prospective comparative trials 8 , 9 , 12 , and two retrospective comparative trials 10 , 11 . There were two studies 7 , 9 using laparoscopic RP, two studies 8 , 11 involving robot-assisted RP, and two studies 10 , 12 applying open retropubic RP. The definition of the ITR-NS and ITE-NS in the included studies is presented in Supplementary Table 2 .…”

“…Study sample sizes ranged from 41 8 and 420 12 . Studies were published from 2010 to 2015 in Europe 7 , 10 – 12 and Asia 8 , 9 . All the studies used bilateral nerve-sparing radical prostatectomy technique.…”

“… Reference Study Surgical approach No. of cases, type Age, yr PSA, ng/ml Size of prostate, ml pT2, % Gleason score 4–6, % Gleason score 7, % Gleason score 8–10, % Stolzenburg 7 RCT Laparoscopic 200 ITR-NS 60 (41–73) 6 (1.0–31) 40 (20–105) 89 51.5 24.5 21 200 ITE-NS 62 (41–75) 6.8 (0.6–24) 44.5 (16–166) 81 45.9 30.1 24 Ko 8 Prospective RARP 9 ITR-NS 52.44 ± 5.38 4.96 ± 1.26 49.94 ± 12.66 100 22.2 77.8 0 32 ITE-NS 59.05 ± 6.95 5.28 ± 2.17 59.09 ± 18.61 100 28.1 71.9 0 Zheng 9 Prospective Laparoscopic 65 ITR-NS 65 (56–70) 5.12 (2.90–7.85) — 86 — — 0 130 ITE-NS 65 (55–69) 5.98 (2.98–8.06) — 80 — — 0 Khoder 10 Retrospective Retropubic 203 ITR-NS 62.7 (35.9–82.1) 5.6 (0.3–9.9) — 93 66.4 32.7 0.9 163 ITE-NS 63.5 (41.1–77.6) 7.0 (0.6–15.0) — …”

“…The majority of the longitudinal controlled studies were considered to have low to moderate risk of bias (Table 4 ). Three studies 7 , 10 , 11 had the proportion of high Gleason score (8–10 score). Patients in one study 8 who underwent RP were relatively younger than those in other studies included in this meta-analysis.…”

Prä-, intra- und postoperative Einflussfaktoren funktioneller Einschränkungen nach radikaler Prostatektomie

“…Für die intrafasziale Technik, welche einer Präparation unmittelbar auf der Prostatakapsel entspricht, konnten bei bilateralem Nerverhalt exzellente Potenz-und Kontinenzraten von jeweils 90 % gezeigt werden [33]. Extra-und interfasziale Präparationstechniken scheinen hinsichtlich der postoperativen Erektionsfähigkeit unterlegen, bieten jedoch bei geringeren R1-Resektionsraten eine größere onkologische Sicherheit [8].…”