INTRAFASCIAL BILATERAL NERVE SPARING RADICAL PROSTATECTOMY: DOES THE ROBOTIC-ASSISTED APPROACH PREDISPOSE TO HIGHER RISK OF POSITIVE SURGICAL MARGINS? IMPORTANCE OF PATIENT SELECTION

1468INTRAFASCIAL BILATERAL NERVE SPARING RADICALPROSTATECTOMY: DOES THE ROBOTIC-ASSISTEDAPPROACH PREDISPOSE TO HIGHER RISK OF POSITIVESURGICAL MARGINS? IMPORTANCE OF PATIENT SELECTIONNazareno Suardi*, Andrea Gallina, Niccolo` Buffi, EmanueleScapaticci, Matteo Zanoni, Giulio Gadda, Giovanni Lughezzani, AldoBocciardi, Luciano Nava, Alberto Briganti, Andrea Cestari, PatrizioRigatti, Giorgio Guazzoni, Francesco Montorsi, milan, ItalyINTRODUCTION AND OBJECTIVES: The effect of the type ofintrafascial approach (open vs robotic assisted) on the rate of positivesurgical margins (PSM) has not been addressed yet. We hypothesizedthat RA intrafascial BNSRP might be associated with a higher risk ofPSM due to a surgical dissection plane potentially closer to the pros-tatic capsule.METHODS: Between 2004 and 2009, 501 consecutive patientsunderwent either open or RA intrafascial BNSRP for clinically localizedPCa. Exclusion criteria for intrafascial approach were: clinical stage T3disease, PSA20 ng/ml or biopsy Gleason sum (GS)8. Patientswere stratified according to surgical approach (open vs RA). Uni andmultivariable logistic regression models tested the association betweensurgical approach and the risk of positive surgical margins (PSM), afteradjusting for PSA, biopsy GS, clinical stage and % of positive cores.The same analyses were repeated in patients with pre-operative verylow-risk patients (PSA10 ng/ml, clinical stage T1, biopsy GS6 and% positive cores33%).RESULTS: 293 (58.5%) and 208 (41.5%) patients were treatedwith open RP and RA BNSRP, respectively. Patients treated with RALPwere younger (mean age: 60.1 vs. 63.5 yrs, p0.001) and had lowerPSA (6.1 vs. 7.1, p0.008). Clinical stage (T2 in 34.6% vs. 16.7%;p0.001) andBiopsy GS(7 in 28.6% vs. 7.7%) were higher in theopen group (p0.001). Patients in RALP group had significantlylower % of positive cores (35.7% vs. 28.4% respectively, p0.02).The rate of PSM washigher in patients submitted to RA BNSRP in theoverall population (22.1% vs. 12.5% respectively, p0.005) as well asin patients with pathologically organ-confined disease (20.0 vs. 9.4%,respectively, p0.02). At multivariable analyses, the surgical approachindependently associated with PSM (p0.01). Patients treated withRALP had a 2.8 fold increased risk of PSM as compared to open.However, when only patients with very low-risk disease were consid-ered (n84), patients treated with RALP had the same rate of PSM ascompared to open(8.7 vs. 2.6% respectively, p0.2). In this category,the surgical approach was not associated with a higher risk of PSM(p0.3).CONCLUSIONS: We demonstrated that patients treated withRA intrafascial BNSRP the has an higher risk of PSM. However, inpatients with very low-risk disease open and RALP intrafascial BNSRPachieve the same PSM rates. Therefore, only highly selected patients(PSA10 ng/ml, clinical stage T1, biopsy GS6 and 33% positivecores) should be candidated to intrafascial RA BNSRP.