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Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.  Labels: BACKGROUND, METHODS, RESULTS. Meshes: Aged, Chi-Square Distribution, Disease-Free Survival, Dissection, Humans, Kaplan-Meier Estimate, Laparoscopy, Male, Middle Aged, Multivariate Analysis, Neoplasm Grading, Odds Ratio, Proportional Hazards Models, Prostate-Specific Antigen, Prostatectomy, Prostatic Neoplasms, Retrospective Studies, Risk Assessment, Risk Factors, Robotics, Surgery, Computer-Assisted, Switzerland, Time Factors, Treatment Outcome.
user
Does intrafascial dissection significantly increase positive surgical margin and biochemical recurrence rates after robotic-assisted radical prostatectomy? Context: Improved visualization and magnification in robot-assisted laparoscopic radical prostatectomy (RALRP) has tempted many urologists to dissect the neurovascular bundle closer to the prostate following the layers of the pseudo-capsule of the prostate. This might bear a higher risk of decreased tumor control. An analysis of a consecutive series of 186 patients who underwent RALRP at our institution was performed. The outcome of patients with intrafascial nerve-sparing (INS) was compared with the outcome of patients who underwent interfascial, extrafascial or no nerve-sparing (non-INS). A total of 80 patients (43.0%) received INS. The overall R1 rate was 27.9%. For pT2 tumors the rate of R1 was 33.8% in INS versus 14.8% in non-INS (odds ratio 2.936, 95% confidence interval 1.338-6.443, p = 0.007). Recurrence-free survival was significantly shorter in INS (p = 0.05; hazard ratio 3.791).
assistant
The intrafascial dissection technique for RALRP bears a high risk of incomplete resection in localized prostate cancer resulting in unfavorable outcome. Final Decision: yes