Robot Assisted Radical Prostatectomy in Kidney Transplant Recipients. Our Clinical Experience and a Systematic Review

Abstract

Introduction: Radical prostatectomy is a more skillful procedure in kidney graft recipients. Robotic surgery can provide a useful minimally invasive tool. Objectives: The study aims to evaluate the robotic-assisted laparoscopic prostatectomy (RALP) in kidney transplant recipients, describing intra/postoperative complications, renal and oncological outcomes. Methods: This is a retrospective study conducted in a single institution of 84 RALP. Four of them were kidney transplant recipients. Side of the renal graft, clinical stage, intra/postoperative events, operating time, creatinine levels before/after intervention and oncologic follow-up were recorded. A systematic review of the literature was performed. Results: Aged 61.25 ± 7.76 years, interval between renal transplantation and RALP: 10 ± 3.16 years. Mean prostate specific antigen: 7.1 ± 2.8 ng/ml, 2 patients were cT1c and 2 cT2a. Preoperative biopsies: Gleason score 3 + 3 in 3 patients, 3 + 4 in 1 patient. Charlson comorbidity index mean was 4.82 ± 0.82. No intra/postoperative events were reported. Mean operating time: 196 ± 20.8 min. Positive surgical margins: 2/4 patients. Pathological analysis: Gleason 3 + 4 in 2 patients and Gleason 3 + 3 in the others 2. A patient developed a bladder neck sclerosis. No differences between pre/postoperative creatinine. Three patients are free of biochemical recurrence and 1 patient required adjuvant radiotherapy. Conclusion: RALP in renal transplant recipients is a safe and feasible technique for localized prostate cancer. No difference in oncological outcomes and no impairments on renal function were found.

Prostate cancer treatment in renal transplant recipients: a systematic review

“…To perform RARP, Polcari et al placed the assistant trocars contralateral to the graft to avert harm by direct instrument passage and to mobilize the bladder only towards this side . Other tips included the exclusion of the port closer to the graft, using only one assistant trocar or not placing the fourth robotic arm, depending on the kidney side , and relocation of all the six trocars contralateral to the graft . A suprapubic port instead of the one ipsilateral to the graft has also been described for extraperitoneal LRP .…”

“…We included 27 studies reporting oncological and/or functional outcomes of PCa treatment in RTRs for a total of 241 patients from 25 cohort studies and nine case reports (Table ). Studies were published between 1991 and 2016 , including patients treated from 1968 . Generally, the quality of the included records was low, with no prospective dataset.…”

“…Data on functional outcomes and complications were available for six and 14 series, respectively, and for all the case reports (Table []). The mean operating time ranged from 92 to 322 min , blood loss (BL) ranged from 50 to 1 466 mL and hospital stay ranged from 1.8 to 11.9 days .…”

“…Four surgical studies stated the antibiotic protocol used, whereas 21 cohort studies did not report any pre‐ peri‐ and/or post‐procedural prophylaxis information. Three studies did not report any infectious complications, using broad spectrum antibiotics ( n = 2) , intravenous ofloxacin and metronidazole suppository, initiated at induction and ended at transit recovery ( n = 9) , and ampicillin plus gentamicin ( n = 4), respectively. By contrast, a study from Germany reported that in 29% of RPP and 7% of RRP cases wound infections occurred using quinolones from day 0 until catheter removal .…”

Robot assisted radical prostatectomy in kidney transplant recipients: surgical, oncological and functional outcomes of two different robotic approaches

“…Although different options have been proposed for the treatment of PCa in KTRs, such as surgery, radiotherapy and brachytherapy (7), radical prostatectomy remains the preferred option. Reasons in favor of surgery could be ascribed to possible complications associated to radiation treatment (RT) in this group of patients (ie.…”