title: The impact of surgical approach (nerve bundle preservation versus wide local excision) on surgical margins and biochemical recurrence following radical prostatectomy.
abstract: OBJECTIVE
  Surgical margin (SM) status is widely reported as a significant risk factor for prostate cancer recurrence following radical prostatectomy (RP). It has been presupposed that preserving the neurovascular bundle may compromise cancer control due to the limited surgical margin obtained with a resultant increase in treatment failure. We examined whether neurovascular bundle preservation during RP is a risk factor for positive SMs and progression-free survival after adjusting for disease severity.
  
  
  METHODS
  Outcomes following RP in 7,268 men between 1990 and 2000 were examined retrospectively. Median followup in those last known to be alive is 6.4 years. RP was performed by a total of 21 surgeons in the same basic fashion with strict attention to anatomical detail.
  
  
  RESULTS
  Overall a positive SM was identified in 38% of patients. The positive SM rate was higher for wide excision than for nerve sparing (NS) (42% vs 34%) (p </= 0.001). The OR for positive SMs in patients undergoing NS-RP was 0.86 (95% CI 0.76 to 0.97, p = 0.012) after incorporating age, clinical stage, biopsy grade, year of surgery and prostate specific antigen. Similarly NS-RP had no significant impact on biochemical progression rates after controlling for these variables (HR 0.98, 95% CI 0.88 to 1.08, p = 0.64).
  
  
  CONCLUSIONS
  NS-RP is not an independent adverse risk factor for positive SMs or progression-free survival. Tumor biology appears set prior to technically skilled anatomical radical prostatectomy independent of wide excision of the neurovascular bundles. All patients with organ confined prostate cancer should be considered candidates for an NS operation.
authors.affiliation: Division of Urology, Department of Surgery, Naval Medical Center, Portsmouth, Virginia, USA. jfward@mar.med.navy.mil
authors.forename: John F
authors.initials: JF
authors.lastname: Ward
authors.forename: Horst
authors.initials: H
authors.lastname: Zincke
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Bergstralh
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Slezak
authors.forename: Robert P
authors.initials: RP
authors.lastname: Myers
authors.forename: Michael L
authors.initials: ML
authors.lastname: Blute
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D015331:Cohort Studies; D018450:Disease Progression; D007172:Erectile Dysfunction / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009367:Neoplasm Staging; D010413:Penis / Q000294:innervation*; D010525:Peripheral Nerves / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen