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

Mistretta, Francesco A.; Galfano, Antonio; Trapani, Ettore Di; Trapani, Dario; Russo, Andrea; Secco, Silvia; Ferro, Matteo; Musi, Gennaro; Bocciardi, Aldo Massimo; Cobelli, Ottavio De

doi:10.1590/s1677-5538.ibju.2018.0308

Cited by 21 publications

(21 citation statements)

References 33 publications

(73 reference statements)

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“…RS-RARP although more demanding than the conventional RARP with a longer learning curve is now considered a safe and feasible approach [14]. Mistretta et al in their series of 9 patients compared outcomes of standard RARP (4 patients) with RS-RARP (5 patients) and concluded that both approaches are safe and feasible in patients with renal transplants with equivalent functional outcomes and oncological outcomes [15]. Our study had comparable results with good oncological outcomes and excellent functional recovery.…”

Section: Discussionsupporting

confidence: 60%

Post-renal Transplant Retzius Sparing Robotic Radical Prostatectomy: Initial Experience and Case Report

Laddha

Pooleri

Raveendran

et al. 2020

SN Compr. Clin. Med.

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Retzius sparing robotic radical prostatectomy is now an accepted alternative to standard RARP. Our paper aims to evaluate the feasibility, complications, and oncological outcomes of the RS-RARP in kidney transplant recipients. We did a retrospective analysis of 3 patients who underwent retzius sparing robotic radical prostatectomy post-renal transplant. Operative, oncological, and functional outcomes are analyzed. A total of 3 patients underwent RS-RARP post-renal transplant. Mean operative time was 143.2 ± 9.06 min, and nerve-sparing was performed on one side in 1 patient. None of the patients had any intraoperative or postoperative events. Final pathological staging was upgraded in all three patients and was pT3aN0Mx. All three patients were fully continent in the immediate postoperative period after catheter removal. All three patients were free of biochemical recurrence with PSA of less than 0.2 in all patients with no need for additional treatment till last follow-up. There was no change in renal function in the immediate postoperative period and 1 month follow-up in any patient. Retzius sparing robotic radical prostatectomy can be performed safely in a post-transplant setting with minimal complications and excellent functional and oncological outcomes.

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Section: Discussionsupporting

confidence: 60%

Post-renal Transplant Retzius Sparing Robotic Radical Prostatectomy: Initial Experience and Case Report

Laddha

Pooleri

Raveendran

et al. 2020

SN Compr. Clin. Med.

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“…The initial electronic search identified a total of 6739 papers. Of these, 4780 publications were identified for detailed review, and ultimately only eight studies were found to meet the inclusion criteria and included in the analysis . Characteristics of the included studies are reported in Table .…”

Section: Resultsmentioning

confidence: 99%

“…A high risk of bias (missing data, measurement of outcomes and selection of the reported results) was recorded for one retrospective study according to the ROBINS‐I tool, whilst a moderate risk of bias was recorded for the other retrospective studies . The three RCTs were mostly found to have a high risk of bias (Fig.…”

Section: Resultsmentioning

confidence: 99%

Retzius‐sparing robot‐assisted radical prostatectomy vs the standard approach: a systematic review and analysis of comparative outcomes

et al. 2019

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Objectives To summarize the current evidence on Retzius‐sparing (RS)‐robot‐assisted radical prostatectomy (RARP) and to compare its oncological, peri‐operative and functional outcomes with those of standard retropubic RARP (S‐RARP). Materials and Methods After establishing an a priori protocol, a systematic electronic literature search was conducted in January 2019 using the Medline (via PubMed), Embase (via Ovid) and Cochrane databases. The search strategy relied on the ‘PICO‘ (Patient Intervention Comparison Outcome) criteria and article selection was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Only studies reporting the oncological and functional outcomes of RARP (as determined by type of procedure [RS‐RARP vs S‐RARP]) were considered for inclusion. Risk of bias and study quality were assessed. Finally, peri‐operative and functional outcomes were recorded and analysed. Results A shorter operating time was associated with RS‐RARP (weighted mean difference [WMD] 14.7 min, 95% confidence interval [CI] −28.25, 1.16; P = 0.03), whereas no significant difference was found in terms of estimated blood loss (WMD 1.45 mL, 95% CI −31.18, 34.08; P = 0.93). Also, no significant difference between the two groups was observed for overall (odds ratio [OR] 0.86, 95% CI 0.40, 1.85; P = 0.71) and major (Clavien >3; OR 0.88, 95% CI 0.30, 2.57) postoperative complications; however, the likelihood of positive surgical margins (PSMs) was lower for the S‐RARP group (rate 15.2% vs 24%; OR 1.71, 95% CI 1.12, 2.60; P = 0.01). The cumulative analysis showed a statistically significant advantage for RS‐RARP in terms of continence recovery at 1 month (OR 2.54, 95% CI 1.16, 5.53; P = 0.02), as well as at 3 months (OR 3.86, 95% CI 2.23, 6.68; P < 0.001), 6 months (OR 3.61, 95% CI 1.88, 6.91; P = 0.001), and 12 months (OR 7.29, 95% CI 1.89, 28.13; P = 0.004). Conclusion Our analysis confirms that RS‐RARP is a safe and feasible alternative to S‐RARP. This novel approach may be associated with faster and higher recovery of continence, without increasing the risk of complications. One caveat might be the higher risk of PSMs, and this can be regarded as a current pitfall of the technique, probably related to an expected learning curve.

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“…In an earlier systematic review, Checcucci et al [8]. It included only two RCTS [24,25], and five non‐RCTS [6,13,35–37]. Rather than analysing both bodies of evidence separately, the authors opted to pool across all studies, which is not recommended.…”

Section: Discussionmentioning

confidence: 99%

Retzius‐sparing versus standard robot‐assisted laparoscopic prostatectomy for the treatment of clinically localized prostate cancer

et al. 2021

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Objectives To assess the effects of Retzius‐sparing (RS) robotic‐assisted laparoscopic prostatectomy (RALP) compared to standard RALP for the treatment of clinically localized prostate cancer. Methods We performed a systematic search of multiple databases and the grey literature with no restrictions on the language of publication or publication status, up until June 2020. We included randomized controlled trials (RCTs) comparing RS‐RALP with standard RALP. We performed a meta‐analysis using a random‐effect model. The quality of evidence was assessed on an outcome basis according to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Results Our search identified six records of five unique RCTs, of which two were published studies, one was in press, and two were abstract proceedings. There were 571 randomized participants, of whom 502 completed the trials. The mean age of participants was 64.6 years and the mean prostate‐specific antigen level was 6.9 ng/mL. Approximately 54.2% of participants had cT1c disease, 38.6% had cT2a‐b disease, and 7.1% had cT2c disease. RS‐RALP probably improves continence within 1 week after catheter removal (risk ratio [RR] 1.74, 95% confidence interval [CI] 1.41–2.14; I2 = 0%; studies = 4; participants = 410; moderate‐certainty evidence). Assuming 335 per 1000 men undergoing standard RALP are continent at this time point, this corresponds to 248 more men per 1000 (137 more to 382 more) reporting continence recovery. RS‐RALP may increase continence at 3 months after surgery compared to standard RALP (RR 1.33, 95% CI 1.06–1.68; I2 = 86%; studies = 5; participants = 526; low‐certainty evidence). Assuming 750 per 1000 men undergoing standard RALP are continent at this time point, this corresponds to 224 more men per 1000 (41 more to 462 more) reporting continence recovery. We are very uncertain about the effects of RS‐RALP on serious adverse events compared to standard RALP (RR 1.40, 95% CI 0.47–4.17; studies = 2; participants = 230; very low‐certainty evidence). Conclusions The findings of this review indicate that RS‐RALP may result in better continence outcomes than standard RALP up to 6 months after surgery. Continence outcomes at 12 months may be similar. The disadvantages of RS‐RALP may be higher positive surgical margin rates. We are very uncertain about the effect on biochemical recurrence‐free survival and potency outcomes. Longer‐term oncological and functional outcomes are lacking, and no preplanned subgroup analyses could be performed to explore the observed heterogeneity. Surgeons should discuss these trade‐offs and the limitations of the evidence with their patients when considering this approach.

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

Cited by 21 publications

References 33 publications

Post-renal Transplant Retzius Sparing Robotic Radical Prostatectomy: Initial Experience and Case Report

Post-renal Transplant Retzius Sparing Robotic Radical Prostatectomy: Initial Experience and Case Report

Retzius‐sparing robot‐assisted radical prostatectomy vs the standard approach: a systematic review and analysis of comparative outcomes

Retzius‐sparing versus standard robot‐assisted laparoscopic prostatectomy for the treatment of clinically localized prostate cancer

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