Impact of intraoperative frozen section analysis (NeuroSAFE) on oncologic and functional outcomes after radical prostatectomy: A systematic review and meta-analysis.

Abstract

373 Background: The NeuroSAFE technique, which provides intraoperative frozen section analysis of the neurovascular bundles, aims to maximize nerve preservation during radical prostatectomy while maintaining oncologic safety. Its efficacy in reducing positive surgical margins (PSM) and improving postoperative functional outcomes remains uncertain. Methods: A systematic review and meta-analysis was conducted according to PRISMA guidelines. PubMed, Scopus, and Embase were searched through January 2025. Eligible studies compared NeuroSAFE-assisted with conventional radical prostatectomy. The primary endpoint was PSM. Secondary endpoints included biochemical recurrence (BCR), urinary continence, and erectile function recovery. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using random-effects models. Heterogeneity was assessed using I² statistics, and publication bias was evaluated with Egger’s and Begg’s tests. Results: Eleven studies involving 15,639 patients (7,244 NeuroSAFE; 8,395 control) were included. NeuroSAFE significantly reduced PSM (OR 0.73, 95% CI 0.59–0.88, p=0.001; I²=76%). No significant difference in BCR was observed (OR 0.82, 95% CI 0.43–1.56, p=0.53). NeuroSAFE improved functional recovery, with higher odds of urinary continence (OR 1.55, 95% CI 1.09–2.20, p=0.014; I²=0%) and erectile function (OR 2.26, 95% CI 1.50–3.41, p<0.001; I²=71%). No significant publication bias was detected. Conclusions: NeuroSAFE significantly decreases positive surgical margins and improves postoperative continence and erectile recovery without compromising biochemical control. These findings support its selective implementation as a quality-enhancing adjunct in nerve-sparing radical prostatectomy. Meta-analysis. Outcome Studies (n) Patients (NeuroSAFE / Control) Pooled OR (95% CI) p-value I² (%) Positive surgical margins 11 7,244 / 8,395 0.73 (0.59–0.88) 0.001 76 Biochemical recurrence 5 1,232 / 1,689 0.82 (0.43–1.56) 0.53 59 Urinary continence 4 599 / 1,803 1.55 (1.09–2.20) 0.014 0 Erectile function 4 630 / 1,791 2.26 (1.50–3.41) <0.001 71