Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug;40(8):1993-1999.
doi: 10.1007/s00345-022-04073-5. Epub 2022 Jun 30.

Challenging cases in high-risk prostate cancer patients treated with Retzius-sparing robot-assisted radical prostatectomy

Stefano Tappero #  1   2   3 , Paolo Dell'Oglio  4   5   6 , Mattia Longoni  4 , Carlo Buratto  4 , Erika Palagonia  4   7 , Pietro Scilipoti  4 , Enrico Vecchio  4   8   9 , Marco Martiriggiano  4   8   9 , Silvia Secco  4 , Alberto Olivero  4 , Michele Barbieri  4 , Giancarlo Napoli  4 , Elena Strada  4 , Giovanni Petralia  4 , Dario Di Trapani  4 , Aldo Massimo Bocciardi  4 , Antonio Galfano  4
Affiliations

Challenging cases in high-risk prostate cancer patients treated with Retzius-sparing robot-assisted radical prostatectomy

Stefano Tappero et al. World J Urol. 2022 Aug.

Abstract

Objective: To evaluate the relationship between enlarged prostate, bulky median lobe (BML) or prior benign prostatic hyperplasia (BPH) surgery and perioperative functional, and oncological outcomes in high-risk (HR) prostate cancer (PCa) patients treated with Retzius-sparing robot-assisted radical prostatectomy (RS-RARP).

Methods: 320 HR-PCa patients treated with RS-RARP between 2011 and 2020 at a single high-volume center. The relationship between prostate volume, BML, prior BPH surgery and perioperative outcomes, Clavien-Dindo (CD) grade ≥ 2 90-day postoperative complications, positive surgical margins (PSMs), and urinary continence (UC) recovery was evaluated respectively in multivariable linear, logistic and Cox regression models. Complications were collected according to the standardized methodology proposed by EAU guidelines. UC recovery was defined as the use of zero or one safety pad.

Results: Overall, 5.9% and 5.6% had respectively a BML or prior BPH surgery. Median PV was 45 g (range: 14-300). The rate of focal and non-focal PSMs was 8.4% and 17.8%. 53% and 10.9% patients had immediate UC recovery and CD ≥ 2. The 1- and 2-yr UC recovery was 84 and 85%. PV (p = 0.03) and prior BPH surgery (p = 0.02) was associated with longer operative time. BML was independent predictor of time to bladder catheter removal (p = 0.001). PV was independent predictor of PSMs (OR: 1.02; p = 0.009). Prior BPH surgery was associated with lower UC recovery (HR: 0.5; p = 0.03).

Conclusion: HR-PCa patients with enlarged prostate have higher risk of PSMs, while patients with prior BPH surgery have suboptimal UC recovery. These findings should help physicians for accurate preoperative counseling and to improve surgical planning in case of HR-PCa patients with challenging features.

Keywords: Challenging scenarios; Functional outcomes; High-risk prostate cancer; Retzius-sparing; Robot-assisted radical prostatectomy.

PubMed Disclaimer

References

    1. Mottet N, van den Bergh RCN, Briers E et al (2021) EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer—2020 update. Part 1: Screening, diagnosis, and local treatment with curative intent. Eur Urol. https://doi.org/10.1016/j.eururo.2020.09.042 - DOI - PubMed
    1. Galfano A, Ascione A, Grimaldi S et al (2010) A new anatomic approach for robot-assisted laparoscopic prostatectomy: a feasibility study for completely intrafascial surgery. Eur Urol. https://doi.org/10.1016/j.eururo.2010.06.008 - DOI - PubMed
    1. Phukan C, Mclean A, Nambiar A et al (2020) Retzius sparing robotic assisted radical prostatectomy vs conventional robotic assisted radical prostatectomy: a systematic review and meta-analysis. World J Urol. https://doi.org/10.1007/s00345-019-02798-4 - DOI - PubMed
    1. Checcucci E, Veccia A, Fiori C et al (2020) Retzius-sparing robot-assisted radical prostatectomy vs the standard approach: a systematic review and analysis of comparative outcomes. BJU Int. https://doi.org/10.1111/bju.14887 - DOI - PubMed - PMC
    1. Rosenberg JE, Jung JH, Edgerton Z et al (2020) Retzius-sparing versus standard robotic-assisted laparoscopic prostatectomy for the treatment of clinically localized prostate cancer. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD013641.pub2 - DOI - PubMed - PMC

LinkOut - more resources