Impact of Partin nomogram on presurgical planning: Intrafascial versus interfascial nerve sparing during robot-assisted radical prostatectomy

We studied the impact of using the Partin nomogram in tailoring the nerve sparing approach during robot-assisted radical prostatectomy. From July 2008 to July 2009, 168 patients underwent robot-assisted radical prostatectomy with bilateral nerves spared. All of the first 70 patients (cohort I) had intrafascial nerve sparing, while the Partin nomogram was used to determine the nerve sparing approach in the next 98 patients (cohort II). In patients with a probability greater than 53% of having pathologically non-organ-confined disease, conventional interfascial nerve sparing was performed; otherwise, intrafascial nerve sparing was carried out. Preoperative patient demographics were similar between the two cohorts. In cohort II, 68 and 30 patients had the bilateral nerves spared intrafascially and interfascially, respectively. Overall, the prevalence of pT3 disease in cohort I was 24.3% and in cohort II was 21.4%. The positive surgical margin rate in cohort I was 15.7% while that in cohort II was 6.1%. There was no significant difference in positive surgical margin rate in organ-confined (pT2) disease between the two groups (7.5 and 5.2%). On the other hand, pT3 positive surgical margin rate was significantly reduced in cohort II (41.2 and 4.8%, P = 0. 013). Using the Partin nomogram in deciding interfascial versus intrafascial nerve sparing during robot-assisted radical prostatectomy gave a significant reduction of positive surgical margin rate in pT3 prostate cancers.