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Objective <p>To evaluate the oncological outcomes and continence recovery of neoadjuvant hormonal therapy (NHT) before robot-assisted laparoscopic radical prostatectomy (RARP) with neurovascular bundle (NVB) preservation in patients with locally advanced prostate cancer (LAPC).</p> Methods <p>Of the 576 patients with LAPC who underwent RARP during January 2016–March 2024, those who received NHT before RARP with NVB preservation (NVB-RARP) were propensity score (PS)-matched with those undergoing RARP without NVB preservation (NNVB-RARP) based on preoperative and histological characteristics. Clinical and biochemical recurrence results were evaluated post-surgically, and postoperative continence was analyzed in the two groups using Kaplan–Meier curves.</p> Results <p>After PS matching, each group was matched with 77 patients. When compared with the NNVB-RARP group, the NVB-RARP group did not show any significant difference in the operation time (102.72 ± 11.64&#xa0;min vs.105.05 ± 16.73&#xa0;min, <i>p</i> = 0.319), postoperative hospitalization time (5.01 ± 0.80 d vs. 5.21 ± 1.13 d, <i>p</i> = 0.248), intraoperative bleeding (158.43 ± 13.76 mL vs. 161.23 ± 15.15 mL, <i>p</i> = 0.232), pathologic tumor stage (≤ pT2) (53.25% vs. 50.65%, <i>p</i> = 0.747), lymph node status (N1) (27.27% vs. 36.36%, <i>p</i> = 0.226), pathological Gleason score (≥ 8) (81.82% vs. 76.62%, <i>p</i> = 0.427), positive surgical margin (15.58% vs. 20.78%, <i>p</i> = 0.403), or complications (9.10% vs.11.69%, <i>p</i> = 0.597). The NVB-RARP group demonstrated significantly faster continence recovery than the NNVB-RARP group (recovery rates: 1 month 42.86% vs. 16.88%, <i>p</i> &lt; 0.001, 3 months 62.34% vs. 36.36%, <i>p</i> = 0.001, and 12 months 83.12% vs. 66.23%, <i>p</i> = 0.016).</p> Conclusion <p>The present findings suggest that NHT before RARP with NVB preservation may enhance continence recovery without compromising the oncological outcomes in patients with LAPC.</p>

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Neurovascular bundle preservation improves postoperative continence recovery in robotic-assisted laparoscopic radical prostatectomy after neoadjuvant hormonal therapy in the treatment of locally advanced prostate cancer: results from a propensity score-matched analysis

  • 期刊论文

  • 发表日期：

    2025年8月31日

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  • Ming Yang,
  • Tianxiao Hong,
  • Hao Ji,
  • Chaoran Zhao,
  • Yamin Wang,
  • Shangqian Wang,
  • Meiling Bao,
  • Pengchao Li

摘要

Objective

To evaluate the oncological outcomes and continence recovery of neoadjuvant hormonal therapy (NHT) before robot-assisted laparoscopic radical prostatectomy (RARP) with neurovascular bundle (NVB) preservation in patients with locally advanced prostate cancer (LAPC).

Methods

Of the 576 patients with LAPC who underwent RARP during January 2016–March 2024, those who received NHT before RARP with NVB preservation (NVB-RARP) were propensity score (PS)-matched with those undergoing RARP without NVB preservation (NNVB-RARP) based on preoperative and histological characteristics. Clinical and biochemical recurrence results were evaluated post-surgically, and postoperative continence was analyzed in the two groups using Kaplan–Meier curves.

Results

After PS matching, each group was matched with 77 patients. When compared with the NNVB-RARP group, the NVB-RARP group did not show any significant difference in the operation time (102.72 ± 11.64 min vs.105.05 ± 16.73 min, p = 0.319), postoperative hospitalization time (5.01 ± 0.80 d vs. 5.21 ± 1.13 d, p = 0.248), intraoperative bleeding (158.43 ± 13.76 mL vs. 161.23 ± 15.15 mL, p = 0.232), pathologic tumor stage (≤ pT2) (53.25% vs. 50.65%, p = 0.747), lymph node status (N1) (27.27% vs. 36.36%, p = 0.226), pathological Gleason score (≥ 8) (81.82% vs. 76.62%, p = 0.427), positive surgical margin (15.58% vs. 20.78%, p = 0.403), or complications (9.10% vs.11.69%, p = 0.597). The NVB-RARP group demonstrated significantly faster continence recovery than the NNVB-RARP group (recovery rates: 1 month 42.86% vs. 16.88%, p < 0.001, 3 months 62.34% vs. 36.36%, p = 0.001, and 12 months 83.12% vs. 66.23%, p = 0.016).

Conclusion

The present findings suggest that NHT before RARP with NVB preservation may enhance continence recovery without compromising the oncological outcomes in patients with LAPC.