I read with great interest the article by Kupski discussing the risk of a positive margin in the intraoperative and final pathology depending on the risk group for biochemical recurrence in biopsy specimens after nerve-sparing (NS) robot-assisted radical prostatectomy (RaRP) [1].
After reading the article, I propose some considerations for which clarification would be helpful.
It seems that NS RaRP was applied to patients in the low, intermediate and high-risk groups of localised prostate cancer, but it was not clearly stated in the study which criteria were used when making the decision to undergo NS surgery. How was the risk of extraprostatic spread evaluated? Was the NS decision made with preoperative magnetic resonance (MR) findings or by using a preoperative nomogram? This is an important factor and should be noted.
There are many studies showing that additional surgical excision reduces the positive surgical margin in the final pathology in patients with a positive intraoperative frozen result of the neurovascular bundle [2, 3, 4].
There were 18 patients with positive surgical margins in the intraoperative frozen examination in your study, but it was stated that only 8 patients had additional surgical excision.
Why was the additional surgical excision not performed in the remaining 10 patients with positive margins?
References
- 1.Kupski T, Małek M, Mor I. The association of a risk group with positive margin in the intraoperative and final pathology examination after robotic radical prostatectomy. Cent European J Urol. 2021;74:491–495. doi: 10.5173/ceju.2021.0031. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Schlomm T, Tennstedt P, Huxhold C, et al. Neurovascular structure-adjacent frozen-section examination (NeuroSAFE) increases nevre-sparing frequency and reduces positive surgical margins in open and robotassisted laparoscopic radical prostatectomy: experience after 11,069 consecutive patients. Eur Urol. 2012;62:333–340. doi: 10.1016/j.eururo.2012.04.057. [DOI] [PubMed] [Google Scholar]
- 3.Vasdev N, Agarwal S, Rai BP, et al. Intraoperative frozen section of the prostate reduces the risk of positive margin whilst ensuring nerve sparing in patients with intermediate and high-risk prostate cancer undergoing robotic radical prostatectomy: first reported UK sweries. Curr Urol. 2016;9:93–103. doi: 10.1159/000442860. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Preisser F, Theissen L, Wild P, et al. Implementation of intraoperative frozen section during radical prostatectomy: short-term results from a German tertiary-care center. Eur Urol Focus. 2021;7:95–101. doi: 10.1016/j.euf.2019.03.007. [DOI] [PubMed] [Google Scholar]