Nerve-sparing robotic-assisted radical prostatectomy is not associated with an increased rate of positive surgical margins

Sep 29, 2026

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Letter to the editor addressing a prior study on nerve-sparing robotic-assisted radical prostatectomy (NS RARP) and its relationship to positive surgical margins (PSMs). The authors agree with the original finding from multivariable analysis that NS RARP does not increase PSM rates, but they highlight concerns about odds ratio interpretation and the wording of univariable results. They argue the data may suggest a lower PSM risk with NS RARP and discuss the broader importance of quality of life and appropriate minimally invasive approaches.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages1

Reading Time3 min

AccessFree to download

Letter to the Editor

Clinical question and response context

Statistical interpretation and wording concerns

Quality of life and minimally invasive surgery rationale

References

. J Chin MedAssoc LETTER TO THE EDITOR Nerve-sparing robotic-assisted radical prostatectomy is not associated with an increased rate of positive surgical margins Yiu-Tai Lia, Wen-Hsun Changb,c,d,* aDepartment of Obstetrics and Gynecology, Kuo General Hospital, Tainan, Taiwan, ROC; bDepartment of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; cInstitute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; dDepartment of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC DEAR EDITOR, We appreciate Dr. Yang’s very kind and immediate response1 to our previous comments,2 which have been published in the February issue of the Journal of the Chinese Medical Association about their original article in the last December issue of the Journal of the Chinese Medical Association entitled “Effects of nerve-sparing procedures on surgical margins after robot-assisted radical prostatectomy”.3 As shown by the authors’ response, nerve-sparing robot-assisted radical prostatectomy (NS RARP) did not show a negative impact on the increased positive surgical margins (PSMs) rate using the multivariable analysis model;1 however, we found that the odds ratio (OR) was less than 1 (0.825), suggesting that it is a trend that prostate cancer patients treated with NS RARP may have a lower risk of PSM than those treated with RARP group, although the difference of PSM between NS RARP and RARP groups did not reach a statistical significance (OR 0.825, 95% confidence interval 0.261-2.602) .1 Additionally, the authors may be at higher risk to mis-interpretate their data based on their description. The authors claimed that PSM rates were reported “higher” in NS groups than in non-NS groups in univariable analysis (29.1% vs 50%; p = 0.047) .1 The aforementioned description in term of “higher” may be mis-interpreted. We supposed the term of “lower” may be a “correct” description, and the description is consistent with the finding that OR is lower than 1. Based on our understanding of their article,2 we do not think that NSRARP may increase the risk of PSM, and by contrast, the risk of PSM may be lower. For cancer treatment, besides the “curability of the diseases,” the quality of life (QoL) has become one of the most important issues for patients. We are happy to learn the feasibility of using a “less invasive” approach in the management of cancer patients if the oncological outcomes are not inferior to the “standard approach”. We highlight the value of minimally invasive surgery in the management of cancer patients after completing adequate preoperative risk stratification and shared decisionmaking between patients and physicians, based on the prediction of higher QoL without compromising the oncological outcomes.4,5 Of course, there is no argument that the minimally invasive approach may not fit all cancer patients who are good candidates for surgical intervention.5,6 REFERENCES 1. Yang CW, Wang HH, Hassouna MF, Chand M, Huang WJ, Chung HJ. Reply to “ The impact of nerve sparing robotic-assisted radical prostatectomy on positive surgical margins: uncertainty”. J Chin Med Assoc 2023;86:255 . 2. Li YT, Chang WH. The impact of nerve sparing robotic-assisted radical prostatectomy on positive surgical margins: uncertainty. J Chin Med Assoc 2023;86:254 . 3. Yang CW, Wang HH, Hassouna MF, Chand M, Huang WJ, Chung HJ. Effects of nerve-sparing procedures on surgical margins after robotassisted radical prostatectomy. J Chin Med Assoc 2022;85:1131–5 . 4. Yang ST, Liu CH, Wang PH. A trend to minimize the radicality of surgery. J Chin Med Assoc 2023;86:5–6 . 5. Liu CH, Yang ST, Wang PH. Organ-or function-preservation surgery is recommended, but who is a candidate? J Chin Med Assoc 2023;86:3–4 . 6. Yang ST, Liu CH, Wang PH. The less invasiveness is and the better quality of life follows: does it fit all early-stage cervical cancer patients? Taiwan J Obstet Gynecol 2022;6

FAQs

What is the main claim of the letter regarding NS RARP and PSM rates?

The letter argues that nerve-sparing robotic-assisted radical prostatectomy (NS RARP) is not associated with an increased rate of positive surgical margins, and may even show a trend toward lower risk.

Why do the authors question the interpretation of the reported results?

They note that the odds ratio is less than 1 with a non-significant confidence interval, suggesting a lower PSM risk rather than an increased one, and they believe the term “higher” could be misleading.

How does the letter connect oncologic outcomes with quality of life?

It emphasizes that, beyond cure, quality of life is crucial and supports considering a less invasive surgical approach when oncological outcomes are not inferior, after appropriate risk stratification and shared decision-making.

Sep 29, 2026

Uploaded by Rizky