Does transition from standard to Retzius-sparing technique in robot-assisted radical prostatectomy affect the functional and oncological outcomes?

Anıl, Hakan; Karamık, Kaan; Yıldız, Ali; Savaş, Murat

doi:10.4081/aiua.2021.4.399

Cited by 3 publications

(14 citation statements)

References 17 publications

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“…Of all patients who underwent salvage radiotherapy, 4/21 (19%) patients in the RS-RARP group and 8/21 (38%) patients in the SA-RARP group had a combination of ISUP 4-5 + pT3 + R1 disease ( p = 0.17). Median follow-up in the SA-RARP and RS-RARP groups was 24.5 [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ] vs. 22 [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ] months, respectively ( p = 0.008).…”

Section: Resultsmentioning

confidence: 99%

“…Anil et al [ 34 ] reported on an analysis of data from a cohort of 50 RS-RARP and 50 SA-RARP patients and retrospectively assessed the safety of the switch from an anterior to a posterior approach. They did not report a significant difference in erectile function recovery, early urinary continence recovery, continence recovery at 1 year postoperatively or positive surgical margins.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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“…Of note, 24 studies comparing RS-RARP to other approaches have been published up to April 15, 2023. Most reports aimed to demonstrate differences between RS-RARP and other approaches in terms of early and late urinary continence (Table 1) [5–8,9 ▪ ,10,11 ▪ ,12–16,17 ▪ ,18,19 ▪ ,20–22,23 ▪ ,24 ▪▪ ,25–28], but none focused on erectile function as primary endpoint. A minority of the studies reported data on sexual function, never finding significant differences among the RARP approaches.…”

Section: Literature Overviewmentioning

confidence: 99%

The spread of retzius-sparing robotic prostatectomy: an update after 10 years

Galfano

Secco

Olivero

et al. 2023

Current Opinion in Urology

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Purpose of reviewObjective of our work is to provide an update of the state of the art concerning Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) and to give a possible vision on the future developments of this new approach.Recent findingsA nonsystematic literature review has been conducted, finding 27 comparative studies and 24 reviews published up to April 15, 2023. Most of these studies confirm the advantages of RS-RARP relative to standard RARP mainly on early continence recovery. Conversely, discordant findings are reported for the benefit of RS-RARP on late continence recovery. Uncertainty is still present on the impact on positive surgical margins (PSMs), but this statement is based on low level of evidence. Several data concerning the learning curve have shown the safety of RS-RARP, but the need of adequate tutoring. Recent studies also confirmed the feasibility of RS-RARP in the setting of high-risk prostate cancer (PCa), large prostate volume, patients with an history of benign prostatic hyperplasia surgery and patients with a transplanted kidney. Atypical advantages can be also seen in the reduction of risk of postoperative inguinal hernias and in case of concomitant rectal resection.SummaryRetzius-sparing RARP has been confirmed to be one of the standard approaches for the treatment of PCa, with well documented advantages and uncertainty on PSMs.

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“…Figure 16). 9,14,[18][19][20]22,23,25 Of the studies included, six reported data about biochemical recurrence (BCR) after a 1-year follow-up. 9,12,16,19,20,24 All of them defined BCR as PSA value ≥ 0.2 ng/mL in two consecutive measures.…”

Section: Oncologic Outcomesmentioning

confidence: 99%

“…The meta-analysis reported no statistically significant intergroup difference (SMD = -0.14; 95% CI = [−0.41 to 0.12]; Figure 20). [9][10][11][12]14,15,[17][18][19][20][21][22]24 3.6 | Length of stay (LOS)…”

Section: Operation Timementioning

confidence: 99%

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

O'Connor‐Cordova,

Macías,

Sancen‐Herrera

et al. 2023

The Prostate

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BackgroundRadical prostatectomy is the standard of care for prostate cancer. Retzius‐sparing robotic‐assisted radical prostatectomy (RS‐RARP) is being widely adopted due to positive functional outcomes compared to conventional robotic‐assisted radical prostatectomy (c‐RARP). Concerns regarding potency, oncological outcomes, and learning curve are still a matter of debate.MethodsFollowing Preferred Instrument for Systematic Reviews and Meta‐Analysis guidelines and PROSPERO registration CRD42023398724, a systematic review was performed in February 2023 on RS‐RARP compared to conventional c‐RARP. Outcomes of interest were continence recovery, potency, positive surgical margins (PSM), biochemical recurrence (BCR), estimated blood loss (EBL), length of stay (LOS), operation time and complications. Data were analyzed using R version 4.2.2.ResultsA total of 17 studies were included, totaling 2751 patients, out of which 1221 underwent RS‐RARP and 1530 underwent c‐RARP. Continence was analyzed using two definitions: zero pad and one safety pad. Cumulative analysis showed with both definitions statistical difference in terms of continence recovery at 1 month (0 pad odds ratio [OR] = 4.57; 95% confidence interval [CI] = [1.32–15.77]; Safety pad OR = 13.19; 95% CI = [8.92–19.49]), as well as at 3 months (0 pad OR, 2.93; 95% CI = [1.57–5.46]; Safety pad OR = 5.31; 95% CI = [1.33–21.13]). Continence recovery at 12 months was higher in the one safety pad group after RS‐RARP (OR = 4.37; 95% CI = [1.97–9.73]). The meta‐analysis revealed that overall PSM rates without pathologic stage classification were not different following RS‐RARP (OR = 1.13; 95% CI = [0.96–1.33]. Analysis according to the tumor stage revealed PSM rates in pT2 and pT3 tumors are not different following RS‐RARP compared to c‐RARP (OR = 1.46; 95% CI = [0.84–2.55]) and (OR = 1.41; 95% CI = [0.93–2.13]), respectively. No difference in potency at 12 months (OR = 0.98; 95% CI = [0.69–1.41], BCR at 12 months (OR = 0.99; 95% CI = [0.46–2.16]), EBL (standardized mean difference [SMD] = −0.01; 95% CI = [−0.31 to 0.29]), LOS (SMD = −0.01; 95% CI = [−0.48 to 0.45]), operation time (SMD = ‐0.14; 95% CI = [−0.41 to 0.12]) or complications (OR = 0.9; 95% CI = [0.62–1.29]) were observed.ConclusionsOur analysis suggests that RS‐RARP is safe and feasible. Faster continence recovery rate is seen after RS‐RARP. Potency outcomes appear to be similar. PSM rates are not different following RS‐RARP regardless of pathologic stage. Further quality studies are needed to confirm these findings.

show abstract

Does transition from standard to Retzius-sparing technique in robot-assisted radical prostatectomy affect the functional and oncological outcomes?

Cited by 3 publications

References 17 publications

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

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

The spread of retzius-sparing robotic prostatectomy: an update after 10 years

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

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