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首页> 外文期刊>Current urology. >Intraoperative Frozen Section of the Prostate Reduces the Risk of Positive Margin Whilst Ensuring Nerve Sparing in Patients with Intermediate and High-Risk Prostate Cancer Undergoing Robotic Radical Prostatectomy: First Reported UK Series
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Intraoperative Frozen Section of the Prostate Reduces the Risk of Positive Margin Whilst Ensuring Nerve Sparing in Patients with Intermediate and High-Risk Prostate Cancer Undergoing Robotic Radical Prostatectomy: First Reported UK Series

机译：前列腺的术中冻结部分降低了积极边缘的风险，同时确保了中间体和高风险前列腺癌患者的神经备受培养，接受了机器人自由基前列腺切除术：首次报道的英国系列

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Introduction: Nerve sparing during robotic radical prostatectomy (RRP) considerably improves post-operative potency and urinary continence as long as it does not compromise oncological outcome. Excision of the neurovascular bundle (NVB) is often performed in patients with intermediate and high risk prostate cancer to reduce the risk of positive surgical margin raising the risk of urinary incontinence and impotence. We present the first UK series outcomes of such patients who underwent an intra-operative frozen section (IOFS) analysis of the prostate during RRP allowing nerve sparing. Patients and Methods: We prospectively analysed the data of 40 patients who underwent an IOFS during RRP at our centre from November 2012 until November 2014. Our IOFS technique involved whole lateral circumferential analysis of the prostate during RRP with the corresponding neurovascular tissue. An intrafascial nerve spare was performed and the specimen was removed intra-operatively via an extension of the 12 mm Autosuture~? camera port without undocking robotic arms. It was then painted by the surgeon and sprayed with "Ink Aid" prior to frozen section analysis. The corresponding NVB was excised if the histopa-thologist found a positive surgical margin on frozen section. Results: Median time to extract the specimen, wound closure and re-establishment of pneumoperitoneum increased the operative time by 8 min. Median blood loss for IOFS was 130 ± 97 ml vs. 90 ± 72 ml (p = NS). IOFS was not associated with major complications or with blood transfusion. PSM decreased significantly from non-IOFS RRP series of 28.7 to 7.8% (p < 0.05). Intra-operative PSM on the prostate specimen was seen in 8/40 margin analysis (20%) leading to an excision of the contra-lateral nerve bundle. On analysis of the nerve bundle on a paraffin embedded block, 6 nerve bundle matched tumor on the specimen whereas 2 NVB were retrospectively removed unnecessarily in our series. All 40 patients have undetectable PSA at a mean follow up of 21.2 months (SD 7.79). Functional data at 18 months confirms a reduction in the urinary incontinence from 37% in the IOFS group vs 57% in the non-IOFS group (p = NS). IOFS technique has resulted in a significant increase in intravesi-cal nerve sparing in both 12/13 patients with intermediate and high risk prostate cancer when appropriately counselled and selected (T2 from 100% in the IOFS group versus 67% and T3 from 100% in the IOFS group to 42%) (p < 0.05). Conclusion: Introduction of the IOFS analysis during intrafascial nerve spare RRP has reduced PSM and the rate of urinary incontinence.
机译：介绍：机器人自由基前列腺切除术（RRP）中的神经备受显着改善了术后效力和泌尿醛，只要它不会损害肿瘤的结果。神经血管束（NVB）的切除通常在中间体和高风险前列腺癌的患者中进行，以降低积极手术边缘的风险，提高尿失禁和阳痿的风险。我们介绍了这种患者的第一个英国系列结果，在RRP期间接受了术语术语术中的冻结部分（IOF）分析，允许神经保留。患者及方法：我们预期分析了40名患者的数据，从2012年11月到2014年11月到2012年11月的RRP期间接受了IOF的患者。我们的IOF技术涉及与相应的神经血管组织的RRP期间前列腺横向周向分析。进行了一种卵慢速度神经备用，通过12mM纯血清延伸，通过延伸术中术中除去样品〜？相机端口而不脱离机器人武器。然后由外科医生涂漆并在冷冻截面分析之前用“墨水助剂”喷洒。如果组织遗传学家在冷冻部分发现正面外科裕度，则切除相应的NVB。结果：提取样品的中位时间，伤口闭合和重新建立肺胆管内的手术时间增加了8分钟。对于IOF的中位失血为130±97ml与90±72ml（p = ns）。 IOF与主要并发症或输血无关。从非IOF的RRP系列28.7％至7.8％（P <0.05），PSM显着降低。在8/40的边缘分析（20％）中观察到前列腺标本上的术语普华氏蛋白，导致对抗侧神经束的切除。在石蜡包埋块上神经束的分析，在试样上的6个神经束匹配肿瘤，而我们的系列中不必要地撤消2个NVB。所有40名患者的均值均为未检测到的PSA，平均在21.2个月内（SD 7.79）。 18个月的功能数据证实，在非IOF组中的IOF组中的37％中的尿失禁降低了（P = NS）。在适当的咨询和选择时，IOF技术在12/13中中间和高风险前列腺癌患者中脑内肌无力培养的显着增加（IOF组100％的T2与100％的T3. IOFS组至42％）（P <0.05）。结论：引入Iofs分析患有血小体神经备用RRP降低了PSM和尿失禁率。

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