Retzius-sparing robot-assisted radical prostatectomy in a medium size oncological center holds adequate oncological and functional outcomes

Abstract

Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) has emerged as a surgical option for patients with prostatic cancer in high-volume centers. The objective is to assess oncological and functional outcomes when implementing RS-RARP in a medium-volume center without previous experience of robotic surgery. This is a prospective observational single-center study. Patients operated between July 2017 and April 2020 were divided into two consecutive groups, A and B, each with 104 patients. The surgeons had prior experience in laparoscopic surgery and underwent robotic training. Positive surgical margin (PSM) status, urinary continence, and erectile function projected by Kaplan–Meier curves, together with patient reported quality of life outcomes at 12 months post-surgery were documented. Median patient age was 63 years (IQR = 59–67), overall PSM rate were 33%, 28% for pT2 disease. Pre-operative values showed no significant difference between both groups. The rate of urinary continence dropped from 81 to 78% (SE = 5.7) (Group A) and from 90 to 72% (SE = 6.3) (Group B) using the International Consultation on Incontinence Questionnaire-Short Form. Baseline sexual function was regained in 41% (Group A) and 47% (Group B) of patients. The median Expanded Prostate Index Composite-26 total score decreased from 86 to 82. These outcomes relate favorably to prior reports. There was a clinically significant decrease in median operative time in the successive groups with post-operative complications occurring in less than 2% of surgical procedures overall. A 12-month follow-up suggests that RS-RARP may be safely introduced in a medium-volume center without previous experience of robotic surgery.

Complications of single‐port robot‐assisted radical prostatectomy: multi‐institutional analysis from the Single‐Port Advanced Research Consortium (SPARC)

“…The relatively low rates of intraoperative complications (0.4%), 90‐day postoperative complications (13%), and readmission (3.9%) appeared to be comparable to those of previous multi‐port RARP series (Table 3) [8–28]. As summarised in Table 3, there were significant heterogeneity in the reporting standards, especially with several studies reporting postoperative complications and readmissions within 30 days [9,13,14,16,17,19].…”

Surgical and functional outcomes of Retzius‐sparing robotic‐assisted radical prostatectomy versus conventional robotic‐assisted radical prostatectomy in patients with biopsy‐confirmed prostate cancer. Are outcomes worth it? Systematic review and meta‐analysis

“…Recently, RS‐RARP has been adopted by some urologic centers, mainly due to the positive functional results reported by Galfano et al, apparently without compromising the pentafecta 4 . This approach allows surgeons to go through the pouch of Douglas and spare the retropubic space, avoiding the transection of the dorsal venous complex and allowing preservation of the puboprostatic ligaments and endopelvic fascia, avoiding adverse functional results 28 . The introduction of RS‐RARP is debatable regarding the prolonged learning curve that may expose the first‐treated patients to a suboptimal standard of care and oncologic outcomes concerns have limited its acceptance.…”

Urinary continence recovery after Retzius-sparing robot-assisted radical prostatectomy in relation to surgeon experience

“…The surgical procedure as regards neurovascular bundle preservation, lymphadenectomy, blood loss, duration of hospital stay and complications according to the Clavien–Dindo classification were recorded as previously described [ 18 ]. An indwelling Foley catheter was kept for at least one week and all patients were considered incontinent in the immediate postoperative period.…”