Outcomes of robot-assisted laparoscopic radical prostatectomy in high-risk prostate cancer patients: experience in 34 patients with oncologic and functional outcomes

Abstract

Introduction:In this retrospective study, we report outcomes of robot-assisted laparoscopic radical prostatectomy (RARP) in high-risk prostate cancer (HRPC) classified according to a D'Amico risk group with minimum 1-year follow-up. Methods: A total of 34 patients who had at least one preoperative HRPC feature and who underwent RARP were included. Mean patient age and preoperative serum prostate-specific antigen levels were 62.6±6.4 years and 12.2±9.1 ng/mL, respectively. Preoperatively, two (5.8%), one (2.9%), eleven (32.3%), three (8.8%), and 17 (50%) patients had prostate biopsy Gleason scores of 5+4, 4+5, 4+4, 3+5, and ,8, respectively. Bilateral neurovascular bundle (NVB)-sparing, unilateral NVB-sparing, and non-NVB-sparing surgery was performed in 16 (47%), five (15%), and 13 (38%) patients, respectively. Results: Mean console time, intraoperative blood loss, duration of hospital stay, and urethral catheter removal time were 162.1±64.4 minutes, 232.2±255.1 cc, 4.1±2.1 days, and 12.6±6.2 days, respectively. During the perioperative period (0-30 days), three minor and five major complications occurred as classified using the modified Clavien classification. No complication was detected during postoperative 31-90 days. Postoperative pathologic stages included pT0, pT2a, pT2b, pT2c, pT3a, and pT3b disease in two (5.8%), five (14.7%), three (8.8%), six (17.6%), ten (29.4%), and eight (23.5%) patients, respectively. Positive surgical margin rate was 32.3%. Mean lymph node yield was 11.8±8.3 (range three to 37). Mean follow-up was 27.8±11.1 months. Biochemical recurrence was detected in nine (26.4%) patients. Of the patients, 17 (50%) were fully continent (zero pads/day), six (17.7%) wore a safety pad/day, six (17.7%) wore one pad/day, three (8.8%) wore two pads/day, and two (5.9%) wore more than two pads/day. Of the 24 patients with no preoperative erectile dysfunction, 15 (44.1%) had no erectile dysfunction at a mean follow-up of 1 year. Trifecta and pentafecta rates were 38% and 26%, respectively. Conclusion: Based on our experience, RARP in HRPC is a safe procedure with satisfactory oncologic and functional outcomes.

Erectile function post robotic radical prostatectomy: technical tips to improve outcomes?

“…With current surgical techniques, trifecta and pentafecta rates were 38 and 26 %, respectively [8], even in high risk cancer patients. Whilst some papers have shown that not all patients undergoing robot-assisted procedures with compete excision of the neurovascular bundle will become impotent (20 % had an erection sufficient for penetration), this is a rarity [9].…”

Outcomes of Robotic Radical Prostatectomy in High-risk Prostate Cancer Patients: Experience in 60 Patients with Oncological and Functional Outcomes

“…We have previously published results from our initial robot-assisted radical prostatectomy (RARP) case series in HRPC. 15 In the current study, we report mid-term functional and oncological results from our contemporary RARP case series in HRPC.…”

Erectile Function Post Robotic Radical Prostectomy: What are the Technical Tips and Tricks?

“…With current surgical techniques, trifecta (oncological control, continence and erectile function outcomes) and pentafecta rates were 38% and 26%, respectively [9], even in high risk cancer patients. Whilst some papers have shown not all patients undergoing robotassisted procedures with compete excision of the neurovascular bundle will become impotent (20% had an erection sufficient for penetration), this is a rarity [10].…”