@Article{cju.2026.077550,
AUTHOR = {Mirjam Naomi Mohr, Arian Farid-Meck, Philipp Henniges, Lutz Trojan, Mathias Reichert},
TITLE = {Equal short-term oncological outcome after secondary resection despite intraoperative upgrading in nerve-sparing prostatectomy under NeuroSAFE control},
JOURNAL = {Canadian Journal of Urology},
VOLUME = {},
YEAR = {},
NUMBER = {},
PAGES = {{pages}},
URL = {http://www.techscience.com/CJU/online/detail/27545},
ISSN = {1488-5581},
ABSTRACT = { <b>Objectives:</b> The risk of biochemical recurrence (BCR) following nerve-sparing (NS) prostatectomy remains controversial, and the natural progression of high-risk prostate carcinoma (PCa) appears to be less favorable than that of low- and intermediate-risk PCa. This study demonstrates that the oncological outcome in high-risk PCa is comparable to that in intermediate- and low-risk PCa after NeuroSAFE-guided NS prostatectomy, due to complete secondary resection (SR) of the neurovascular bundle (NVB) on the affected side. <b>Methods:</b> BCR, as well as associated risk factors, were evaluated 12 months after radical robot-assisted laparoscopic prostatectomy (RALP) performed as curative treatment for localized PCa (n = 784, treated between September 2019 and November 2023). Accordingly, the occurrence of BCR following NS RALP with complete SR of the NVB was compared across different subgroups, including primary surgical approach and final surgical approach with or without SR. <b>Results:</b> A total of 784 RALPs were included in the statistical analysis, with follow-up available for 725 patients (92.5%). BCR occurred in 10.6% of patients (n = 77). An initial NS approach was performed in 472 patients. BCR rates did not differ significantly between patients undergoing NS with SR (n = 162) and those undergoing NS without SR (n = 310) (<i>p</i> = 0.445), despite significant differences in tumor characteristics between the groups (e.g., UICC stage; <i>p</i> = 0.034). After exclusion of patients with biopsy-proven high-risk PCa, BCR rates remained comparable between the SR (n = 138) and non-SR (n = 176) groups (<i>p</i> = 0.520), despite persistent significant differences in postsurgical tumor characteristics (e.g., UICC stage; <i>p</i> &lt; 0.001). SR itself did not have a significant impact on the risk of BCR in any of the subgroup analyses. <b>Conclusions:</b> The results of this study indicate that planned NS, despite intraoperative upgrading of PCa, does not result in inferior short-term oncological outcomes when complete SR of the positive surgical margin–affected NVB is performed. Complete SR yields comparable BCR rates across both higher- and lower PCa risk groups. Therefore, an NS approach should be pursued whenever feasible to optimize functional outcomes.},
DOI = {10.32604/cju.2026.077550}
}