Folie: 1 HELIOS Kliniken Leipziger Land K. Kuhnt D. Schulz NESA DAYS 2006 HELIOS Kliniken Leipziger Land Positive margins and early postop potency after Nerve-sparing ELRP Kai Kuhnt ChA Dr. med. Dietmar Schulz Abteilung für Urologie HELIOS Klinik Borna Leipziger Land Germany Incidence of positive surgical margins and early postoperative potency outcome after nerve-sparing extraperitoneal laparoscopic radical prostatectomy
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HELIOS Kliniken Leipziger Land Folie: 1 K. Kuhnt D. Schulz NESA DAYS 2006 Positive margins and early postop potency after Nerve-sparing ELRP Kai Kuhnt.
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Folie: 1
HELIOS Kliniken Leipziger Land
K. Kuhnt D. Schulz NESA DAYS 2006HELIOS Kliniken Leipziger Land
Positive margins and
early postop potency after
Nerve-sparing ELRP
Kai Kuhnt ChA Dr. med. Dietmar Schulz
Abteilung für UrologieHELIOS Klinik Borna
Leipziger Land Germany
Incidence of positive surgical margins and early postoperative potency outcome after nerve-sparing extraperitoneal laparoscopic radical prostatectomy
Folie: 2
K. Kuhnt D. Schulz NESA DAYS 2006HELIOS Kliniken Leipziger Land
Prostate Cancer
• Most frequent malignant tumor in Urology
• 2. most frequent tumor in men
• if organ confined
radical prostatectomy
other (Brachytherapy, Radiotherapy, Hormonetherapy,
watchful waiting…)
Folie: 3
K. Kuhnt D. Schulz NESA DAYS 2006HELIOS Kliniken Leipziger Land
Radical Prostatectomy
• Open surgery
– retropubic
– perineal
• Laparosopic
– transperitoneal / extraperitoneal
– robot assisted
– antegrade / retrograde
– not nerve sparing / nerve sparing
Folie: 4
K. Kuhnt D. Schulz NESA DAYS 2006HELIOS Kliniken Leipziger Land
Nerve sparing prostatectomy
Goal:
Preservation of the „Neurovascular Bundle“ dorsolaterally of the Prostate …
Leading to higher postoperative potency rate …
Improving Quality of Life www.prostatecancercentre.co.uk
Folie: 5
K. Kuhnt D. Schulz NESA DAYS 2006HELIOS Kliniken Leipziger Land
Nerve-Sparing ELRP
Indication for Nerve-Sparing:
• Low-risk cancer– PSA ≤ 10 ng/ml– T ≤ 2– G ≤ 2– Gleason sum ≤ 7
• Preoperative potency• Patient‘s decision
Folie: 6
K. Kuhnt D. Schulz NESA DAYS 2006HELIOS Kliniken Leipziger Land
Why positive surgical margins ?
Factors that might influence the incidence ofpositive surgical margins in nerve-sparing prostatectomy (I)
• Staging error:
clinical vs. pathological staging and grading
• Patient selection (indication?)
• Cancer volume and topography
• Volume of specimen in relation to patient’s pelvis
Folie: 7
K. Kuhnt D. Schulz NESA DAYS 2006HELIOS Kliniken Leipziger Land
Positive surgical margins
Factors: why PSM ? (II)
• Obliteration of dissection plane
due to previous core biopsies
• Prostatitis and Periprostatitis
• Previous TUR-P transurethral resection of prostate
• Neoadjuvant antiandrogen therapy
Folie: 8
K. Kuhnt D. Schulz NESA DAYS 2006HELIOS Kliniken Leipziger Land
Positive surgical margins
Factors: why PSM ? (III)
• Technique of haemostasis: - Increased insufflation pressure
- Local haemostatics
- Bipolar
- Clips
- Suture-ligature
• Availability of intraoperative frozen sections (IFS)
analysis
• Location of intraoperative frozen sections
Folie: 9
K. Kuhnt D. Schulz NESA DAYS 2006HELIOS Kliniken Leipziger Land