A systematic review of the effects of nerve sparing during radical prostatectomy

Abstract

This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement (2009). MEDLINE, EMBASE, The Cochrane Library, Health Technology Assessment Database, and Web of Science were searched from 1966 to December 2015, yielding 60 records.

RCTs and other controlled or comparative studies were eligible for inclusion. Studies reporting on at least one of the following outcomes, positive surgical margins, continence and potency with data available for nerve sparing and non-nerve sparing groups were included. 16 studies were available for final analysis and included 16269 participants.

Primary outcomes analysed where positive surgical margins and functional outcomes (continence and potency).

Comparing nerve sparing with non-nerve sparing prostatectomy, the proportion of cases resulting in incontinence is lower for nerve sparing prostatectomy.

The proportions of cases resulting in impotence were 0.92 (Cl: 0.88 – 0.96) for non-nerve sparing operations, 0.43 (Cl: 0.40 – 0.46) for all nerve sparing operations, 0.59 (CI: 0.51 – 0.67) for unilateral and 0.39 (CI: 0.35 – 0.42) for bilateral nerve sparing.

With regards to positive margin rates, these are higher for T3 cancers than for T2 cancers, both for operations that used nerve sparing and for those that did not. For T2 cancers there is little or no difference in the proportion of cases resulting in positive margins for operations with and without nerve sparing. For T3 cancers the proportions of cases with positive margins were practically the same for operations with and without nerve sparing .