The efficacy and utilisation of preoperative multiparametric magnetic resonance imaging in robot-assisted radical prostatectomy: does it change the surgical dissection plan?

Abstract

Objective: We investigated the effect of the use of multiparametric prostate magnetic resonance imaging (mp-MRI) on the dissection plan of the neurovascular bundle and the oncological results of our patients who underwent robot-assisted radical prostatectomy. Material and methods:We prospectively evaluated 60 consecutive patients, including 30 patients who had (Group 1), and 30 patients who had not (Group 2) mp-MRI before robot-assisted radical prostatectomy. Based on the findings of mp-MRI, the dissection plan was changed as intrafascial, interfascial, and extrafascial in the mp-MRI group. Two groups were compared in terms of age, prostate-specific antigen (PSA), Gleason sum scores and surgical margin positivity.Results: There was no statistically significant difference between the two groups in terms of age, PSA, biopsy Gleason score, final pathological Gleason score and surgical margin positivity. mp-MRI changed the initial surgical plan in 18 of 30 patients (60%) in Group 1. In seventeen of these patients (56%) surgical plan was changed from non-nerve sparing to interfascial nerve sparing plan. In one patient dissection plan was changed to non-nerve sparing technique which had extraprostatic extension on final pathology. Surgical margin positivity was similar in Groups 1, and 2 (16% and 13%, respectively) although, Group 1 had higher number of high-risk patients. mp-MRI confirmed the primary tumour localisation in the final pathology in 27 of of 30 patients (90%). Conclusion:Preoperative mp-MRI effected the decision to perform a nerve-sparing technique in 56% of the patients in our study; moreover, changing the dissection plan from non-nerve-sparing technique to a nerve sparing technique did not increase the rate of surgical margin positivity.Keywords: Dissection; magnetic resonance; prostate; prostatectomy.Cite this article as: Tavukçu HH, Aytaç Ö, Balcı NC, Kulaksızoğlu H, Atuğ F. The efficacy and utilisation of preoperative multiparametric magnetic resonance ımaging in robot-assisted radical prostatectomy: does it change the surgical dissection plan? Turk J Urol 2017; 43(4): 470-5.

“Real-time” Assessment of Surgical Margins During Radical Prostatectomy: State-of-the-Art

“…Several authors studied the clinical value of preoperative MRI on surgical planning and PSM rates showing that it may influence the surgical decision in 26% to 59% of patients. [65][66][67][68][69][70] Recently, Kozikowski et al 71 reported, in their systematic review and meta-analysis, that MRI modified the NVB dissection on 1 or both sides in 35% of patients, of which 63% performed a more aggressive resection of the bundle and 37% had more preservation of the bundle. Furthermore, they showed that the appropriateness of the surgical decision modification based on the MRI findings was 77%.…”