Retzius-sparing robot-assisted radical prostatectomy versus open retropubic radical prostatectomy: a prospective comparative study with 19-month follow-up

Raheem, Ali Abdel; Hagras, Ayman; Ghaith, Ahmed; Alenzi, Mohamed J.; Elghiaty, Ahmed; Gameel, Tarek; Alowidah, Ibrahim; Ham, Won Sik; Choi, Young Deuk; Elbahnasy, Abdelhamid M.; Omar, Adel; Elbendary, Mohamed; Rha, Koon Ho

doi:10.23736/s0393-2249.20.03830-8

Cited by 13 publications

(13 citation statements)

References 33 publications

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“…The one-year postoperative continence rate in our study was similar to previously reported data, in which one-year continence rates after RS-RARP of 90–100% have been reported [ 17 , 19 , 20 , 21 , 23 , 24 ]. The one-year continence rate after SA-RARP in our study is at the lower bound of those reported in literature, which greatly vary between 70–95% [ 25 , 26 ].…”

Section: Discussionsupporting

confidence: 92%

“…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%

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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: Discussionsupporting

confidence: 92%

Section: Resultsmentioning

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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“…Intriguingly, the statistical difference in the PSM rate between the T-RARP and S-RARP groups was insignificant, which may be explained by the fact that the procedure of T-RARP after bladder neck excision was carried out similarly to S-RARP. Given that the more extensive the cancer, the higher the risk of positive margins (38), the PSM rate obtained following the posterior RARP had reached up to 50% in pT3 diseases in the series reported by Abdel et al (39). The relatively low rate of PSM in our T-RARP group could be partly interpreted with the extreme scarcity of pT3 prostate tumors included in our analysis, while the reported PSM rates after the posterior approach were 14-27% with more pT3 prostate tumors enrolled (5,7,39,40).…”

Section: Discussionmentioning

confidence: 96%

“…Given that the more extensive the cancer, the higher the risk of positive margins (38), the PSM rate obtained following the posterior RARP had reached up to 50% in pT3 diseases in the series reported by Abdel et al (39). The relatively low rate of PSM in our T-RARP group could be partly interpreted with the extreme scarcity of pT3 prostate tumors included in our analysis, while the reported PSM rates after the posterior approach were 14-27% with more pT3 prostate tumors enrolled (5,7,39,40). A larger working space provided by the suspension stitches during T-RARP was also conducive to achieve negative surgical margins when compared with the posterior approach to RARP.…”

Section: Discussionmentioning

confidence: 96%

Transvesical Retzius-Sparing Versus Standard Robot-Assisted Radical Prostatectomy: A Retrospective Propensity Score-Adjusted Analysis

et al. 2021

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ObjectivesTo estimate the safety and efficiency of transvesical Retzius-sparing robot-assisted radical prostatectomy (T-RARP) compared with standard robot-assisted radical prostatectomy (S-RARP) for localized prostate cancer (PCa).Materials and Methods174 patients bearing localized PCa and undergoing T-RARP or S-RARP between October 2017 and January 2020 were retrospectively enrolled in our analysis. All potential baseline confounders were strictly restrained with propensity-score matching (PM) method (1: 1). Within the matched setting, the perioperative and functional outcomes were compared between the T-RARP and S-RARP groups, while the oncological results and functional recovery of the two arms were presented with Kaplan-Meier curves.ResultsFinally, 114 and 60 eligible patients harbouring localized PCa were identified in the S-RARP and T-RARP group, respectively. No significant differences between the two groups were found in all baseline characteristics after PM. Within the matched cohort, no case was converted to open surgery in either group. The T-RARP group was significantly related to a higher mean operative time (p = 0.001) and shorter median hospital stay length (p < 0.001). There were not significant differences in the median estimated blood loss and specimen Gleason score between the two arms. The proportions of transfusion, pT3a disease, postoperative complication, and positive surgical margin in the T-RARP group were also comparable to that in the S-RARP group. The mean prostate-specific antigen and median erectile functional scores did not differ significantly between the two groups at postoperative 3 months and last follow-up. T-RARP vs. S-RARP had significantly improved urinary continence (UC) rates at the removal of catheter (p < 0.001) and postoperative 3 months (p < 0.001), but the significant difference between the two groups in UC recovery disappeared at last follow-up (p = 0.119). No significant difference in biochemical recurrence-free survival was observed following the two surgeries (p = 0.727).ConclusionsT-RARP by experienced hands was feasible for selected patients with clinically localized PCa, yielding significantly improved early return to UC and similar erectile functional preservation without compromising oncological control when compared with the standard approach.

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“…Initial reports of this technique showed a high T2‐positive margin rate compared with matched traditional robotic prostatectomy. Subsequently, several series have been published 20–22 . There is a trend to higher positive margins.…”

Section: Robotic Radical Prostatectomymentioning

confidence: 99%

Robotics in Australian urology contemporary practice and future perspectives

Furrer

Costello

Thomas

et al. 2021

ANZ Journal of Surgery

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Retzius-sparing robot-assisted radical prostatectomy versus open retropubic radical prostatectomy: a prospective comparative study with 19-month follow-up

Cited by 13 publications

References 33 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?

Transvesical Retzius-Sparing Versus Standard Robot-Assisted Radical Prostatectomy: A Retrospective Propensity Score-Adjusted Analysis

Robotics in Australian urology contemporary practice and future perspectives

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