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The author(s) commend the attempt but raise questions about reported clinical versus pathological T stage counts, calculation and group sizes for unilateral, bilateral, and non-nerve-sparing procedures, and interpretation of statistical versus clinical significance. Additional requests include clarifying model-based risk findings and comparing PSM between nerve-sparing and non–nerve-sparing RARP, emphasizing clinically meaningful conclusions.",{"@graph":69,"@context":126},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/the-impact-of-nerve-sparing-robotic-assisted-radical-prostatectomy-on-positive-surgical-margins-uncertainty-letter-to-the-editor/436864/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/the-impact-of-nerve-sparing-robotic-assisted-radical-prostatectomy-on-positive-surgical-margins-uncertainty-letter-to-the-editor/436864.png","ImageObject",300,407,{"name":92,"@type":93},"Putri","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-09-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":14},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118,122],{"name":109,"@type":110,"acceptedAnswer":111},"What is the main concern raised about the nerve-sparing RARP study?","Question",{"text":112,"@type":113},"The letter questions whether the study’s conclusions about increased positive surgical margin (PSM) risk are adequately supported and interpretable, especially regarding how results were calculated and analyzed.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Why does the author question the clinical vs pathological T stage numbers?",{"text":117,"@type":113},"The cited paper enrolled 419 prostate cancer patients, but only 417 had a pathological T stage versus 419 with a clinical T stage; the letter asks for an explanation of this discrepancy.",{"name":119,"@type":110,"acceptedAnswer":120},"What additional clarifications are requested about PSM rates and group composition?",{"text":121,"@type":113},"The letter asks for the exact patient counts in unilateral, bilateral NS RARP, and traditional RARP groups and how the reported PSM percentages were calculated, as well as clarification of the statistical analysis based on “artificial or manual models.”",{"name":123,"@type":110,"acceptedAnswer":124},"What emphasis does the letter make regarding significance?",{"text":125,"@type":113},"It stresses the need for meaningful and useful clinical guidance: statistical significance should be interpreted very carefully without clinically meaningful recommendations.","https://schema.org",{"og:url":83,"og:type":128,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":130,"canonical":83},"index,follow",{"doc_id":132,"site_id":62},436864,1790795185,{"code":4,"msg":5,"data":135},{"doc_id":132,"user_id":136,"nickname":92,"user_avatar":137,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":138,"file_id":139,"file_url":140,"file_type":141,"file_size":142,"view_count":14,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":8,"language":143,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":144,"faqs":145,"seo_title":146,"seo_description":67,"update_tm":147,"read_time":81},962085571259,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","J Chin MedAssoc  \nLETTER TO THE EDITOR  \nThe impact of nerve-sparing robotic-assisted radical prostatectomy on positive surgical margins: Uncertainty  \nYiu-Tai Lia, Wen-Hsun Changb,c,d,*  \naDepartment 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  \nDear Editor,  \nWe read with great interest the recent publication in the Journal of the Chinese Medical Association entitled “Effects of nerve-sparing procedures on surgical margins after robotassisted radical prostatectomy.”1 The authors attempted to evaluate the feasibility and oncological safety of using nervesparing (NS) robot-assisted radical prostatectomy (RARP) in the management of prostate cancer (PC) patients.1 They used the “presence of positive surgical margins (PSM)” as a marker to test their hypothesis.1 The authors found the unilateral NS RARP had an increased PSM rate compared to those in either complete NS RARP (odd ratio [OR] 2.187) or non-NS RARP (OR 2.237) with a statistically significant difference, contributing to their conclusion of concern about the oncological safety (a higher risk of the presence of PSM) of using unilateral NS RARP in the management of PC patients.1 We applauded their success, although they did not provide additional information addressing the preoperative or postoperative risk stratification to improve personalized risk assessment in PC patients and subsequently guided further therapeutic choice (NS RARP) to minimize the adverse events without compromising the therapeutic effects compared to the standard RAPR surgery. In fact, this concept of using the strict criteria to select a certain population of any cancer patients for minimally invasive surgery and/or less radical surgery to minimize the risk of therapy-related toxicity is of paramount importance.2–4 However, we are confused about some of their descriptions, and we hope to see their response.  \nThe authors enrolled 419 PC patients undergoing RARP, but 417 patients had a pathological T stage compared to 419 patients with a clinical T stage.1 Could the authors explain the discrepancy between both?  \nAdditionally, the audience may be confused about how many patients were treated with unilateral, bilateral, and nonNS RARP (traditional RARP) . Furthermore, the PSM rates of PC patients treated by unilateral, bilateral NS RARP, and  \ntraditional RARP were 30.3%, 28.8%, and 50%, respectively, as described by the authors. Could the authors clearly demonstrate how to calculate the aforementioned percentage? Please provide the accurate number of patients in each group. Based on their data, RARP seemed to have a 50% probability of the presence of PSM (50compared to either 30.3% in a unilateral NS RARP group or 28.8% in a bilateral NS RARP group, respectively) . However, it is confusing to us since the authors said that after application of “artificial or manual models” to analyze their data, they found the risk of PSM was statistically significantly increased in the unilateral NS RARP group, although they claimed this finding was obtained from “statistical analysis.”  \nIf possible, could the authors investigate the difference in PSM between NS RARP (a combination of unilateral NS RARP and bilateral NS RARP) and RARP?  \nFinally, we should emphasize the importance of meaningful and useful information between clinical significance and statistical significance. Without a clinically meaningful recommendation, it should be interpreted very carefully.5,6  \nREFERENCES  \n1. 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 .  \n2. Wang PH, Yang ST, Liu CH, Chang WH, Lee FK, ","cbCairo1FLD0vdDU","https://ap.wps.com/l/cbCairo1FLD0vdDU","pdf",283488,"English","# Letter to the Editor\n## Background and context of the cited study\n## Questions about patient staging discrepancy\n## Clarification requests for surgical groups and PSM calculations\n## Interpretation of model-based statistical results\n## Request for comparison between NS RARP and RARP","[{\"question\":\"What is the main concern raised about the nerve-sparing RARP study?\",\"answer\":\"The letter questions whether the study’s conclusions about increased positive surgical margin (PSM) risk are adequately supported and interpretable, especially regarding how results were calculated and analyzed.\"},{\"question\":\"Why does the author question the clinical vs pathological T stage numbers?\",\"answer\":\"The cited paper enrolled 419 prostate cancer patients, but only 417 had a pathological T stage versus 419 with a clinical T stage; the letter asks for an explanation of this discrepancy.\"},{\"question\":\"What additional clarifications are requested about PSM rates and group composition?\",\"answer\":\"The letter asks for the exact patient counts in unilateral, bilateral NS RARP, and traditional RARP groups and how the reported PSM percentages were calculated, as well as clarification of the statistical analysis based on “artificial or manual models.”\"},{\"question\":\"What emphasis does the letter make regarding significance?\",\"answer\":\"It stresses the need for meaningful and useful clinical guidance: statistical significance should be interpreted very carefully without clinically meaningful recommendations.\"}]","The impact of nerve-sparing robotic-assisted radical prostatectomy on positive surgical margins: Uncertainty - Letter to the Editor | PDF",1790679267]