Effects of Nerve-Sparing Procedures on Surgical Margins after Robot-assisted Radical Prostatectomy

Sep 29, 2026

Uploaded by Jake

Nerve-sparing (NS) techniques used during robot-assisted radical prostatectomy (RARP) may elevate positive surgical margin (PSM) rates, yet published findings differ across patient groups. This single-surgeon study from 2010–2018 evaluated how unilateral, bilateral, and complete or partial NS approaches affect margin status in site-specific prostate lobes. Multivariable analysis assessed NS procedures alongside other covariates to clarify their influence on margin outcomes.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Abstract

Introduction

Methods

Data collection

J Chin MedAssoc Original article Effects of nerve-sparing procedures on surgical margins after robot-assisted radical prostatectomy Ching-Wei Yanga,b,c,d, Hsiao-Hsien Wanga, Mohamed Fayez Hassounad, Manish Chandd,e, William J. Huangc,f, Hsiao-Jen Chungc,f,* aDepartment of Urology, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC; bInstitute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei Taiwan, ROC; cShu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; dWellcome EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom; eDepartment of Colorectal Surgery, University College London Hospital, London, United Kingdom; fDepartment of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC Abstract Background: Nerve-sparing (NS) techniques could potentially increase positive surgical margins after robot-assisted radical prostatectomy (RARP) . Nevertheless, the available studies have revealed ambiguous results among distinct groups. This study purposed to clarify the details of NS techniques to accurately estimate their influence on margin status. Methods: We studied RARPs performed by one surgeon from 2010 to 2018. Surgical margins were evaluated by the laterality and levels of NS techniques in site-specific prostate lobes. The multivariable analysis evaluated the effects of nerve-sparing procedures, combined with other covariate factors, on margin status. Results: Overall, 419 RARPs involving 838 prostate lobes were analyzed. Notably, 181 patients (43 .4%) had pT2-stage, and 236 (56 .6%) had pT3-stage cancer. The PSM rates for patients who underwent unilateral, bilateral, and non NS procedures were 30.3%, 28.8%, and 50%, respectively (p = 0 .233) or in stratification by pT2 (p = 0 .584) and pT3 (p = 0 . 116) stage. The posterolateral PSM rates among site-specific prostate lobes were 10.9%, 22.4%, and 18.9% for complete, partial, and non NS techniques, respectively (p = 0.001) . The partial NS group revealed a significant increase in PSM rate compared with the complete NS (OR 2. 187, 95% CI: 1.19–4.03) and non NS (OR 2.237, 95% CI: 1.01–4.93) groups in site-specific prostate lobes. Conclusion: Partial NS procedures have a potential risk of increasing the positive surgical margins rate than complete and non NS procedures do. Therefore, correct case selection is required before performing partial NS techniques. Keywords: Margins of excision; Prostatic neoplasms; Prostatectomy; Robotic surgical procedures 1. INTRODUCTION In 1982, Dr. Patrick Walsh intraoperatively identified theneurovascular bundle (NVB) and performed the first nervesparing (NS) prostatectomy. Postoperatively, the patient experienced an excellent recovery of sexual function and no prostate-specific antigen (PSA) elevation for 25 years.1 * Address correspondence Dr. Hsiao-Jen Chung, Department of Urology, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, [ROC. E-mail address: hjchung@vghtpe.gov.tw](ROC. E-mail address: hjchung@vghtpe.gov.tw) (H.-J. Chung). Conflicts of interest: Dr. William J. Huang, an editorial board member at Journal of the Chinese Medical Association, had no role in the peer review process of or decision to publish this article. The other authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article. Journal of Chinese Medical Association. (2022) 85: 1131-1135. Received March 28, 2022; accepted August 18, 2022. doi: 10. 1097/JCMA.0000000000000810. Copyright © 2022, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/](http://creativecommons.org/licenses/)[ ](http://creativecommons.org/licenses/)[by-nc-nd/4.0/](by-nc-nd/4.0/)) Typically, NS procedures are performed on a minimal and tight dissection plane to

FAQs

What is the main purpose of this study on nerve-sparing (NS) techniques?

To clarify how different NS techniques influence surgical margin status after robot-assisted radical prostatectomy (RARP).

How were surgical margins evaluated in the study?

Margin status was assessed by laterality and by levels of NS techniques across site-specific prostate lobes, followed by multivariable analysis including other covariates.

What did the results suggest about partial NS procedures compared with complete NS and non-NS?

Partial NS procedures showed a higher risk of increasing the positive surgical margin rate than complete NS and non-NS approaches, supporting the need for correct case selection.

Sep 29, 2026

Uploaded by Jake