Retzius-sparing robot-assisted laparoscopic radical prostatectomy: functional and early oncologic results in aggressive and locally advanced prostate cancer

Abstract

BackgroundRetzius-sparing robot-assisted laparoscopic radical prostatectomy (rsRARP) allows entire prostatectomy procedure via the pouch of Douglas. In low- and intermediate-risk prostate cancer (PCa) there is level 1 evidence that the Retzius-sparing approach impacts early continence recovery. Since specific data on aggressive and locally advanced cancer is lacking and avoiding rsRARP is presently suggested, we investigated urinary and sexual recovery, perioperative complications and early oncologic outcomes after rsRARP in this particular cohort.MethodsProspectively collected data of 50 consecutive men (median age 66 years) with high-risk PCa who underwent rsRARP in a single institution was analysed retrospectively. The follow-up for all patients was 12 months after surgery.Results3 vs. 12 months after surgery, 82% vs. 98% of men used no pad or one safety pad and 50% vs. 72% used no pad. 89% of patients did not observe a decline of continence if postoperative radiotherapy was carried out.Considering the 17 preoperatively potent patients who underwent bi- or unilateral nerve-sparing surgery, 41% reported their first sexual intercourse within 1 year after rsRARP.84% of patients had ≥pT3a disease and 42% positive surgical margins. A lymphadenectomy was done in 94% of patients with a median lymph node removal of 15 and lymph node metastasis in 13%.34% underwent adjuvant radiotherapy and 22% adjuvant androgen deprivation therapy (ADT). 1-year recurrence-free survival was 96%, including 25% of patients on adjuvant or salvage ADT.ConclusionsRsRARP in high-risk PCa is feasible and results in excellent continence rates, even after postoperative radiotherapy. The potency rates are promising but need further clarification in larger cohorts. Reliable oncologic outcomes require longterm follow-up and are awaited.

Short Term Outcomes in Indian Patients with High Risk Prostate Cancer after Laparoscopic Radical Prostatectomy- Data from a Single Institute

“…Similarly the distribution of biopsy GS was variable. A score below 8 in more than half of the cases was reported by few authors [11,14,16,18,19]; while a score of 8 or more was noted by others, including us [5,10,17]. However, patient's clinical stage in our study was similar to the other reports.…”

“…PSA distribution among the various other studies of HRPC treatment by RP was not uniform ( Table 5). Mean PSA around 10ng/ml was found in a few studies [7,10,14,15,16,17] while a value between 15-25ng/ml was observed in others, including in our study [5,11,18,19]. Similarly the distribution of biopsy GS was variable.…”

“Maximum Preservation Radical Prostatectomy”: Oncological, functional and other contemporary aspects of Retzius Sparing Robotic Assisted Radical Prostatectomy

“…Since almost all studies focused on low-and intermediaterisk PCa, there is a gap in reporting the RS approach for the high-risk and locally advanced disease. Nyarangi, et al published the results of a cohort of 50 men with high-risk PCa treated with RS-RARP, after 1 year of follow-up, and found that this approach is feasible, oncologically safe, associated with few perioperative complications and offers good results regarding recovery of urinary continence but long term oncological outcomes are awaited and the irst results from erectile function need to be con irmed [46].…”

“…As a new technical alternative, long-term oncological outcomes remain unclear and the surgeon must pay attention to own surgical margins and compare with videotapes to improve personal results. In experienced hands since high risk cases can be performed with acceptable results [52].…”

Complex space of Retzius lymphocele resulting in iliac compression and submassive pulmonary embolism after robotic Retzius sparing prostatectomy

“… 2 Among Retzius sparing radical prostatectomy (RS-RARP), lymphoceles have been reported in 10% of PLNDs for intermediate and high-risk prostate cancer. 3 We present a unique case of submassive pulmonary embolisms (PE) potentially caused by iliac compression by a large complex space of Retzius lymphocele after a RS-RARP.…”