Role of multiparametric 3.0 tesla magnetic resonance imaging for decision�making to preserve or resect neurovascular bundles at robotic assisted laparoscopic radical prostatectomy
To evaluate the accuracy of preoperative multiparametric 3.0–T magnetic resonance imaging(MRI) for local staging of prostate cancer(PCa) and its influence on the decision to preserve neurovascular bundles(NVB) at robotic–assisted laparoscopic radical prostatectomy(RALRP).
Materials and methods:
Between 2008 and 2011, 353 patients, who had confirmed PCa and underwent preoperative MRI and RALRP, were included. The extent of NVB sparing was initially determined on the basis of the clinical information and nerve sparing surgical plan was reevaluated after review of the MRI report. The value of preoperative MRI in the prediction of extracapsular extension(ECE) and in the decision of surgical plan according to D’Amico risk classification were analyzed.
The MRI performed correct, over– and under– staging in 261(73.9%), 43(12.2%), and 49(13.9%) patients, respectively. After review of the MRI reports, the initial surgical plan was not changed in 260 patients(260/353, 74%) and changed in 93 patients(93/353, 26%). RALRP was changed to a more preservable NVB sparing procedure in 53 patients(53/93, 57%) and changed to a more aggressive NVB resecting procedure in 40 patients(40/93, 43%). For the patients with a change to more conservative surgery, the appropriateness was 91%. The sensitivity of MRI in predicting ECE showed a tendency to increase from low to high risk groups(33%,46%,80%, respectively; p<0.001). In intermediate and high risk groups, there was a surgical plan change in 40 patients(40/129, 31%) and 27 patients(27/67, 40%), respectively.
The preoperative MRI significantly improves the decision–making to preserve or resect the NVB at RALRP which lacks haptic feedback.