Does prostate volume have an impact on the functional and oncological results of Retzius-sparing robot-assisted radical prostatectomy?

Galfano, Antonio; Panarello, Daniele; Secco, Silvia; Trapani, Dario; Barbieri, Michele; Napoli, Grazia; Strada, E.; Petralia, Giovanni; Bocciardi, Aldo Massimo

doi:10.23736/s0393-2249.18.03069-2

Cited by 32 publications

(20 citation statements)

References 13 publications

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“…Fourth, non-regarding of the surgical approach (ORP vs. RARP) prostate volume and BMI did not represent risk factors for PSM in patients undergoing RP. However, there is some evidence in literature that there may be a difference in PSM in larger prostates and especially in ORP (22,23). These differences are mainly driven by very large prostate volumes and low patient numbers within those groups.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Adverse Patient Characteristics on Perioperative Outcomes in Open and Robot-Assisted Radical Prostatectomy

et al. 2020

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Section: Discussionmentioning

confidence: 99%

The Effect of Adverse Patient Characteristics on Perioperative Outcomes in Open and Robot-Assisted Radical Prostatectomy

et al. 2020

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“…1A), suggesting that there is still a margin of improvement. Indeed, more recent series reported median console time of <90 min [20].…”

Section: Discussionmentioning

confidence: 99%

Retzius‐sparing robot‐assisted radical prostatectomy: early learning curve experience in three continents

et al. 2020

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Objective To assess the effect of surgical experience on peri‐operative, functional and oncological outcomes during the first 50 Retzius‐sparing robot‐assisted radical prostatectomy (RsRARP) cases performed by surgeons naïve to this novel approach. Materials and Methods We retrospectively evaluated the initial cases operated by 14 surgeons in 12 different international centres. Pre‐, peri‐ and postoperative features of the first 50 patients operated by each surgeon in all the participating centres were collected. The effect of surgical experience on peri‐operative, functional and oncological outcomes was firstly evaluated after stratification by level of surgical experience (initial [≤25 cases] and expert [>25 cases]) and after using locally weighted scatterplot smoothing to graphically explore the relationship between surgical experience and the outcomes of interest. Results We evaluated 626 patients. The median follow‐up was 13 months in the initial group and 9 months in the expert group (P = 0.002). Preoperative features overlapped between the two groups. Shorter console time (140 vs 120 min; P = 0.001) and a trend towards lower complications rates (13 vs 5.5%; P = 0.038) were observed in the expert group. The relationship between surgical experience and console time, immediate urinary continence recovery and Clavien–Dindo grade ≥2 complications was linear, without reaching a plateau, after 50 cases. Conversely, a non‐linear relationship was observed between surgical experience and positive surgical margins (PSMs). Conclusions In this first report of a multicentre experience of RsRARP during the learning curve, we found that console time, immediate urinary continence recovery and postoperative complications are optimal from the beginning and further quickly improve during the learning process, while PSM rates did not clearly improve over the first 50 cases.

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“…In 2010, a revolutionary surgical technique for RARP was described by Bocciardi et al. known as the posterior or ‘Retzius‐sparing’ (RS) approach, which may allow earlier continence recovery . An increasing number of institutions worldwide have explored the feasibility and reproducibility of this approach, and studies comparing standard retropubic RARP (S‐RARP) and the posterior (RS‐RARP) procedure have been reported, with controversial results .…”

Section: Introductionmentioning

confidence: 99%

Retzius‐sparing robot‐assisted radical prostatectomy vs the standard approach: a systematic review and analysis of comparative outcomes

et al. 2019

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Objectives To summarize the current evidence on Retzius‐sparing (RS)‐robot‐assisted radical prostatectomy (RARP) and to compare its oncological, peri‐operative and functional outcomes with those of standard retropubic RARP (S‐RARP). Materials and Methods After establishing an a priori protocol, a systematic electronic literature search was conducted in January 2019 using the Medline (via PubMed), Embase (via Ovid) and Cochrane databases. The search strategy relied on the ‘PICO‘ (Patient Intervention Comparison Outcome) criteria and article selection was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Only studies reporting the oncological and functional outcomes of RARP (as determined by type of procedure [RS‐RARP vs S‐RARP]) were considered for inclusion. Risk of bias and study quality were assessed. Finally, peri‐operative and functional outcomes were recorded and analysed. Results A shorter operating time was associated with RS‐RARP (weighted mean difference [WMD] 14.7 min, 95% confidence interval [CI] −28.25, 1.16; P = 0.03), whereas no significant difference was found in terms of estimated blood loss (WMD 1.45 mL, 95% CI −31.18, 34.08; P = 0.93). Also, no significant difference between the two groups was observed for overall (odds ratio [OR] 0.86, 95% CI 0.40, 1.85; P = 0.71) and major (Clavien >3; OR 0.88, 95% CI 0.30, 2.57) postoperative complications; however, the likelihood of positive surgical margins (PSMs) was lower for the S‐RARP group (rate 15.2% vs 24%; OR 1.71, 95% CI 1.12, 2.60; P = 0.01). The cumulative analysis showed a statistically significant advantage for RS‐RARP in terms of continence recovery at 1 month (OR 2.54, 95% CI 1.16, 5.53; P = 0.02), as well as at 3 months (OR 3.86, 95% CI 2.23, 6.68; P < 0.001), 6 months (OR 3.61, 95% CI 1.88, 6.91; P = 0.001), and 12 months (OR 7.29, 95% CI 1.89, 28.13; P = 0.004). Conclusion Our analysis confirms that RS‐RARP is a safe and feasible alternative to S‐RARP. This novel approach may be associated with faster and higher recovery of continence, without increasing the risk of complications. One caveat might be the higher risk of PSMs, and this can be regarded as a current pitfall of the technique, probably related to an expected learning curve.

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Does prostate volume have an impact on the functional and oncological results of Retzius-sparing robot-assisted radical prostatectomy?

Cited by 32 publications

References 13 publications

The Effect of Adverse Patient Characteristics on Perioperative Outcomes in Open and Robot-Assisted Radical Prostatectomy

The Effect of Adverse Patient Characteristics on Perioperative Outcomes in Open and Robot-Assisted Radical Prostatectomy

Retzius‐sparing robot‐assisted radical prostatectomy: early learning curve experience in three continents

Retzius‐sparing robot‐assisted radical prostatectomy vs the standard approach: a systematic review and analysis of comparative outcomes

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