RARP(Robotic Assisted Radical Prostatectomy)

Abstract

Radical prostatectomy remains an important means to treat prostate cancer. A major limiting factor to radical prostatectomy is short- and long-term complications, especially incontinence and sexual dysfunction. With the advent of robotic radical prostatectomy.

Positive surgical margins at robot-assisted radical prostatectomy were found less frequently in patients who underwent multiparametric MR imaging–directed intraoperative frozen-section analysis than in control patients (7.5% vs 18.7%, P = .01).

Purpose

To investigate whether use of multiparametric magnetic resonance (MR) imaging–directed intraoperative frozen-section (IFS) analysis during nerve-sparing robot-assisted radical prostatectomy reduces the rate of positive surgical margins.

Materials and Methods

This retrospective analysis of prospectively acquired data was approved by an institutional ethics committee, and the requirement for informed consent was waived. Data were reviewed for 134 patients who underwent preoperative multiparametric MR imaging (T2 weighted, diffusion weighted, and dynamic contrast-material enhanced) and nerve-sparing robot-assisted radical prostatectomy, during which IFS analysis was used, and secondary resections were performed when IFS results were positive for cancer. Control patients (n = 134) matched for age, prostate-specific antigen level, and stage were selected from a pool of 322 patients who underwent nerve-sparing robot-assisted radical prostatectomy without multiparametric MR imaging and IFS analysis. Rates of positive surgical margins were compared by means of the McNemar test, and a multivariate conditional logistic regression model was used to estimate the odds ratio of positive surgical margins for patients who underwent MR imaging and IFS analysis compared with control subjects.

Conclusion

The significantly lower rate of positive surgical margins compared with that in control patients provides preliminary evidence of the positive clinical effect of multiparametric MR imaging–directed IFS analysis for patients who undergo prostatectomy.