Is It Safe to Switch from a Standard Anterior to Retzius-Sparing Approach in Robot-Assisted Radical Prostatectomy?

Author:

Lambert Edward12,Allaeys Charlotte1,Berquin Camille1,De Visschere Pieter3,Verbeke Sofie4ORCID,Vanneste Ben56,Fonteyne Valerie5,Van Praet Charles1,Lumen Nicolaas1

Affiliation:

1. ERN eUROGEN Accredited Centre, Department of Urology, Ghent University Hospital, 9000 Ghent, Belgium

2. Junior ERUS/YAU Working Group on Robot-Assisted Surgery of the European Association of Urology, 6803 AA Arnhem, The Netherlands

3. Department of Radiology and Nuclear Medicine, Ghent University Hospital, 9000 Ghent, Belgium

4. Department of Pathology, Ghent University Hospital, 9000 Ghent, Belgium

5. Department of Radiation Oncology, Ghent University Hospital, 9000 Ghent, Belgium

6. Department of Radiation Oncology (MAASTRO), GROW—School for Oncology and Developmental Biology, Maastricht UMC, 6229 HX Maastricht, The Netherlands

Abstract

Background: Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) has been shown to lead to better outcomes regarding early continence compared to standard anterior RARP (SA-RARP). The goal of this study was to assess the feasibility and safety of implementing RS-RARP in a tertiary center with experience in SA-RARP. Methods: From February 2020, all newly diagnosed non-metastatic prostate cancer patients for whom RARP was indicated were evaluated for RS-RARP. Data from the first 100 RS-RARP patients were prospectively collected and compared with data from the last 100 SA-RARP patients. Patients were evaluated for Clavien Dindo grade ≥3a complications, urinary continence after 2 and 6 weeks, 3, 6 and 12 months, erectile function, positive surgical margins (PSMs) and biochemical recurrence (BCR). Results: There was no significant difference in postoperative complications at Clavien-Dindo grade ≥3a (SA-RARP: 6, RS-RARP: 4; p = 0.292). At all time points, significantly higher proportions of RS-RARP patients were continent (p < 0.001). No significant differences in postoperative potency were observed (52% vs. 59%, respectively, p = 0.608). PSMs were more frequent in the RS-RARP group (43% vs. 29%, p = 0.034), especially in locally advanced tumors (pT3: 64.6% vs. 43.8%, p = 0.041—pT2: 23.5% vs. 15.4%, p = 0.329). The one-year BCR-free survival was 82.6% vs. 81.6% in the SA-RARP and RS-RARP groups, respectively (p = 0.567). The median follow-up was 22 [18–27] vs. 24.5 [17–35] months in the RS-RARP and SA-RARP groups, respectively (p = 0.008). Conclusions: The transition from SA-RARP to RS-RARP can be safely performed by surgeons proficient in SA-RARP. Continence results after RS-RARP were significantly better at any time point. A higher proportion of PSMs was observed, although it did not result in a worse BCR-free survival.

Publisher

MDPI AG

Reference35 articles.

1. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries;Sung;CA Cancer J. Clin.,2021

2. Laparoscopic and Robotic-Assisted versus Open Radical Prostatectomy for the Treatment of Localised Prostate Cancer;Ilic;Cochrane Database Syst. Rev.,2017

3. Robotic Surgery in Comparison to the Open and Laparoscopic Approaches in the Field of Urology: A Systematic Review;Zahid;J. Robot. Surg.,2022

4. Vattikuti Institute Prostatectomy: Technical Modifications in 2009;Menon;Eur. Urol.,2009

5. A New Anatomic Approach for Robot-Assisted Laparoscopic Prostatectomy: A Feasibility Study for Completely Intrafascial Surgery;Galfano;Eur. Urol.,2010

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