Functional and Oncologic Outcomes Comparing Interfascial and Intrafascial Nerve Sparing in Robot-Assisted Laparoscopic Radical Prostatectomies

Abstract

Introduction: The impact of intrafascial versus interfascial nerve sparing during radical prostatectomy on oncologic and postoperative outcome is still controversial. This manuscript compares the outcomes of intrafascial versus interfascial techniques of nerve sparing used during robot-assisted laparoscopic radical prostatectomy (RALRP) at our institution. Materials and Methods: Of the 171 patients who underwent RALRP at our institution from January 2006 through December 2007, the charts of 147 patients who underwent bilateral nerve sparing procedure were reviewed retrospectively. During the study period, the preferred technique of nerve sparing at our institution changed from the conventional interfascial approach to athermal intrafascial robotic (AIR) approach. The rates of positive surgical margins (+SMs), continence, and potency were measured. Results: Perioperative characteristics and complication rates were similar between the two groups. Continence rates at 1, 3, and 6 months increased from 27.3%, 68.8%, and 93.5%, respectively, after the interfascial procedure to 68.6%, 84.3%, and 92.9% after the AIR procedure. Potency rates at 3, 6, and 9 months in the interfascial group were 16.7%, 43.8%, and 66.7%, respectively, whereas in the AIR group they improved to 24.2%, 81.8%, and 90.9%. The rates of +SMs in pT2 disease were 5.88% in the interfascial group and 7.55% in the AIR group (not significant), whereas in pT3, +SMs were 22.2% in the interfascial group and 41.18% in the AIR group (p < 0.05). Conclusion: AIR technique greatly improved potency rate and shortened the time to return of continence following RALRP. This improved outcome, though, was achieved at the price of higher +SM rates in patients with pT3 disease.