Intraoperative technologies to assess margin status during radical prostatectomy - a narrative review.

IF 5.1 2区 医学 Q1 ONCOLOGY Prostate Cancer and Prostatic Diseases Pub Date : 2024-07-18 DOI:10.1038/s41391-024-00868-2
O Windisch, M Diana, D Tilki, G Marra, A Martini, M Valerio
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Abstract

Positive surgical margin (PSM) is a frequent concern for surgeons performing radical prostatectomy for prostate cancer (PCa). PSM are recognized as risk factors for earlier biochemical recurrence and expose patients to adjuvant or salvage treatments such as external radiotherapy and hormonotherapy. Several strategies have been established to reduce PSM rate, while still allowing safe nerve-sparing surgery. Precise preoperative staging by multiparametric magnetic resonance imaging (mpMRI) and fusion biopsy is recommended to identify suspicious areas of extracapsular extension (ECE) that warrant special attention during dissection. However, even with optimal imaging, ECE can be missed, some cancers are not well defined or visible, and capsular incision during surgery remains an issue. Hence, intraoperative frozen section techniques, such as the neurovascular structure-adjacent frozen section examination (NeuroSAFE) have been developed and lately widely disseminated. The NeuroSAFE technique reduces PSM rate while allowing higher rate of nerve-sparing surgery. However, its use is limited to high volume or expert center because of its high barrier-to-entry in terms of logistics, human resources and expertise, as well as cost. Also, NeuroSAFE is a time-consuming process, even in expert hands. To address these issues, several technologies have been developed for an ex vivo and in vivo use. Ex vivo technology such as fluorescent confocal microscopy and intraoperative PET-CT require the extraction of the specimen for preparation, and digital images acquisition. In vivo technology, such as augmented reality based on mpMRI images and PSMA-fluorescent guided surgery have the advantage to provide an intracorporeal analysis of the completeness of the resection. The current manuscript provides a narrative review of established techniques, and details several new and promising techniques for intraoperative PSM assessment.

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根治性前列腺切除术中评估边缘状态的术中技术 - 综述。
手术切缘阳性(PSM)是外科医生对前列腺癌(PCa)进行根治性前列腺切除术时经常会遇到的问题。手术切缘阳性被认为是早期生化复发的风险因素,并使患者面临辅助或挽救治疗,如体外放射治疗和激素治疗。目前已制定了几种策略来降低 PSM 发生率,同时仍能进行安全的保留神经手术。建议通过多参数磁共振成像(mpMRI)和融合活检进行精确的术前分期,以确定可疑的囊外扩展(ECE)区域,从而在解剖时给予特别关注。然而,即使采用了最佳的成像技术,ECE 仍有可能被遗漏,有些癌症的定义不清或不可见,手术中的囊切口仍是一个问题。因此,术中冰冻切片技术(如神经血管结构邻近冰冻切片检查(NeuroSAFE))应运而生,并在近期得到广泛传播。NeuroSAFE 技术可降低 PSM 发生率,同时提高神经保留手术率。然而,由于其在物流、人力资源和专业知识以及成本方面的高门槛,其使用仅限于高容量或专家中心。此外,即使在专家手中,NeuroSAFE 也是一个耗时的过程。为了解决这些问题,已经开发出几种体内外使用的技术。体外技术,如荧光共聚焦显微镜和术中 PET-CT,需要提取标本进行准备,并获取数字图像。体内技术,如基于 mpMRI 图像的增强现实技术和 PSMA 荧光引导手术,则具有提供切除完整性体内分析的优势。本手稿对已有技术进行了叙述性回顾,并详细介绍了几种用于术中 PSM 评估的前景广阔的新技术。
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来源期刊
Prostate Cancer and Prostatic Diseases
Prostate Cancer and Prostatic Diseases 医学-泌尿学与肾脏学
CiteScore
10.00
自引率
6.20%
发文量
142
审稿时长
6-12 weeks
期刊介绍: Prostate Cancer and Prostatic Diseases covers all aspects of prostatic diseases, in particular prostate cancer, the subject of intensive basic and clinical research world-wide. The journal also reports on exciting new developments being made in diagnosis, surgery, radiotherapy, drug discovery and medical management. Prostate Cancer and Prostatic Diseases is of interest to surgeons, oncologists and clinicians treating patients and to those involved in research into diseases of the prostate. The journal covers the three main areas - prostate cancer, male LUTS and prostatitis. Prostate Cancer and Prostatic Diseases publishes original research articles, reviews, topical comment and critical appraisals of scientific meetings and the latest books. The journal also contains a calendar of forthcoming scientific meetings. The Editors and a distinguished Editorial Board ensure that submitted articles receive fast and efficient attention and are refereed to the highest possible scientific standard. A fast track system is available for topical articles of particular significance.
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