Ces Urol 2021, 25(3):193-203 | DOI: 10.48095/cccu2021030

Peroperative histology during robotic-assisted radical prostatectomy with lymphadenectomy: a feasibility study

Vladimír Študent ml.¹, Daniela Kurfürstová², Daniela Skanderová², Zuzana Seifriedová¹, Ondřej Česák¹, Hana Študentová³, Dana Purová¹, Vladimír Študent¹

¹ Urologická klinika FN Olomouc a LF UP Olomouc

² Ústav klinické a molekulární patologie FN Olomouc a LF UP Olomouc

³ Onkologická klinika FN Olomouc a LF UP Olomouc

Študent V ml., Kurfürstová D, Skanderová D, Seifriedová Z, Česák O, Študentová H, Purová D, Študent V. Peroperative histology during robotic-assisted radical prostatectomy with lymphadenectomy: a feasibility study.

Introduction: Peroperative histology (IFS) during robot-assisted radical prostatectomy (RARP) is used to ensure better oncological outcomes of surgery and, thanks to the possibility of safer nerve-sparing surgery (NS), which could improve functional outcomes such as continence. and erection.

Aim: This work aims to develop our own IFS technique, verify its feasibility and describe its peroperative results in patients indicated for RARP with extended pelvic lymphadenectomy (ePLND).

Materials and methods: From September 2020 to May 2021, 21 RARPs with ePLNDs were performed with IFS (intervention group). The control group (n = 42) was selected from a database of patients with RARP with ePLND without IFS operated on between December 2019 and May 2021. The control group was assigned in a 2 : 1 ratio based on age, body mass index (BMI), and risk classification groups for biochemical recurrence (EAU risk groups). The IFS technique was developed, its reliability and effect on the length of the operation, the number of positive surgical margins (PSM), and the extended PSM (ePSM, defined as PSM in multiple locations or PSM one location with a length greater than 3 mm) were verified. In the case of a positive finding on IFS, periprostatic tissue resection was performed. Baseline and perioperative results were evaluated in both groups.

Results: The two groups did not differ in preoperative and pathological characteristics. The duration of surgery was longer in the intervention group (median 176 minutes, interquartile range - IQR 151-183 vs. 145 minutes, IQR 133-164, p = 0.0003). The time from specimen removal to reporting the IFS result was 55 minutes (median), IQR 52-64 minutes. The number of patients with a positive margin (PSM) was in the intervention group 6 (28,6%), while only three patients (14.3%) had an ePSM finding. In the control group, 18 patients with PSM were described (42%), while in 3 (7.1%), ePSM was found. Although the groups did not differ in the total number of PSM (p = 0.593), in the control group, there was a smaller number of patients with ePSM (p = 0.031). The degree of agreement of IFS with the definitive histopathological finding was 90.5%. The percentage of complete removal of the tumor by secondary resection was 28.6%. Conslusion: We have demonstrated the feasibility of IFS in RARP with ePLND in the Czech healthcare system. IFS showed good agreement with the definitive histopathological evaluation. It is associated with longer operation time. IFS did not improve overall PSM in this cohort but contributed to complete tumor resection in one-third of PSM patients. This feasibility study helped to gain experience with IFS and led to the launch of another study with more patients.

Keywords: Prostate cancer, robot-assisted radical prostatectomy, nerve-sparing, neurosafe, peroperative histology, positive surgical margins.

Received: June 22, 2021; Revised: July 13, 2021; Accepted: August 2, 2021; Prepublished online: August 2, 2021; Published: September 30, 2021