Perioperative and short‐term outcomes of Retzius‐sparing robot‐assisted laparoscopic radical prostatectomy stratified by gland size

Abstract

ObjectiveTo investigate the effect of preoperative prostate volume (PV) on the perioperative, continence and early oncological outcomes among patients treated with Retzius-sparing robotassisted laparoscopic radical prostatectomy (RS-RALP). Patients and MethodsThis is a retrospective analysis of 294 patients with organconfined prostate cancer treated with RS-RALP in a highvolume centre from November 2012 to February 2015. Patients were divided into three groups based on their transrectal ultrasonography estimated PV as follows: group 1, <40 mL (231 patients); group 2, 40-60 mL (47); group 3, >60 mL (16). Perioperative, oncological, and continence outcomes were compared between the three groups. ResultsThe median [interquartile range (IQR)] PV for each group was; 26.1 (22-31) mL, 45.9 (41-50) mL, and 70 (68-85) mL. Blood loss was higher in group 3 compared to groups 2 and 1; at a median (IQR) of 475 (312-575) mL, 200 (150-400) mL, and 250 (150-400) mL, respectively (P = 0.001). The intraoperative transfusion rate was higher in group 3 patients (P = 0.004), while the complication rate did not differ (P = 0.05). The console time was slightly higher but was not statistically significant in group 3 compared to groups 2 and 1; at a mean (SD) of 100 (35) min, 92 (34.4) min, and 93 (24.8) min, respectively (P = 0.70). Biochemical recurrence and the continence rate did not differ between the three groups (P = 0.89 and P = 0.25, respectively). ConclusionRS-RALP is oncologically and functionally equivalent for all prostate sizes but technically demanding for larger prostates. We therefore recommend that surgeons initiate their RS-RALP technique with smaller prostates.

Retzius‐sparing robot‐assisted radical prostatectomy using the Revo‐i robotic surgical system: surgical technique and results of the first human trial

“…In the present study we achieved similar results to those of previous RS-RARP reports using the da Vinci system [13,15,16]. In the present study the PSM rate was 18.8% in pT2 disease and 100% in pT3 disease, in a recent randomized control trial by Dalela et al [16], the PSM rate was 25% among patients with low-and intermediate-risk PCa treated with RS-RARP.…”

“…Previously, we investigated the impact of prostate volume on the peri‐operative, continence and early oncological outcomes of RS‐RARP (Table ). We found that patients with prostate volumes >60 mL were at risk of higher EBL, blood transfusion and longer length of hospital stay . This was attributable to the limited working space during surgery, which may be more apparent in men with large prostates and a broad prostate base with a wide vascular pedicle, which increases the complexity of dissection.…”

Retzius-sparing Robotic-assisted Radical Prostatectomy Associated with Less Bladder Neck Descent and Better Early Continence Outcome

“…Prostate size was not an independent risk factor of incontinence after operation in our series, and this result was also observed in the Retzius-sparing RARP group by Lim et al (13). They claimed that large prostate size appears to be equivocally relative to oncological and continence outcomes and was not associated with a longer operative or console time, despite the increased surgical difficulty (13).…”

“…They claimed that large prostate size appears to be equivocally relative to oncological and continence outcomes and was not associated with a longer operative or console time, despite the increased surgical difficulty (13).…”

Is Retzius-sparing robot-assisted radical prostatectomy associated with better functional and oncological outcomes? Literature review and meta-analysis

“…Our literature search yielded 11 studies addressing RS-RARP technique: One randomized control trial (RCT), six observational studies, two case reports, one case series and one descriptive study [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] . We observed a lack of consistency among the parameters in the studies.…”