Nerve-sparing effect on margins

Highlights from the Canadian Urological Association Annual Meeting, Montreal, June 2011

In treating prostate cancer, physicians face the ongoing challenge of balancing cancer control with minimizing side effects that affect men’s functioning and quality of life. Nerve-sparing surgery — in which the nerves on either side of the prostate gland are left intact — is an example of an effort made to reduce one of these side effects, erectile dysfunction. However, a study looking at bilateral nerve-sparing has found that it may be associated with positive surgical margins (i.e. cancer extends to the edge of the removed tissue). The presence of positive margins without evidence of tumour extension beyond the prostate is called capsular incision (CI) and is known to reduce recurrence-free survival.

Preston et al conducted a retrospective review of 9,915 prostate cancer patients treated in two hospital centres (Ottawa and New York) to evaluate the effect of nerve-sparing surgery on CI. Patients had open, laparoscopic or robotic prostatectomy. Approximately 6% of them had CI; of these, the occurrence was significantly higher in men who had bilateral nerve-sparing compared to those who had non-nerve-sparing surgery. CI was more frequently observed with robotic surgery than with either open or laparoscopic procedures. The study concluded that bilateral nerve-sparing during RP significantly increases the chances of CI.