Extraperitoneal laparoscopic versus transperitoneal robot-assisted laparoscopic approaches during radical prostatectomy for low-risk or intermediate-risk prostate cancer

Abstract

Background: Extraperitoneal laparoscopic radical prostatectomy (E-LRP) and transperitoneal robotic-assisted laparoscopic radical prostatectomy (TRA-LRP) are two types of radical prostatectomy widely used at present, but the comparative study between them is limited. We aimed to compare E-LRP with TRA-LRP in the treatment of low- or intermediate-risk prostate cancer (PCa).

Methods: From June 2020 to May 2024, in our department, a total of 80 patients with low- or intermediate-risk PCa, including 45 cases who received E-LRP (E-LRP group) and another 35 cases who received TRA-LRP (TRA-LRP group), were enrolled in our research. All patients were followed up for 6-24 months. Perioperative parameters, erectile function, urinary continence, and biochemical recurrence were compared between the 2 groups.

Results: Patients in the TRA-LRP group had longer operative times (165.3 vs. 128.4 min, P<0.05), lesser blood loss (89.6 vs. 139.4 mL, P<0.05), and lower positive surgical margin (PSM) rate (17.1% vs. 37.8%, P<0.05) compared with the E-LRP group. Potent patients who received TRA-LRP showed better potency recovery than those who received E-LRP at 6 months postoperatively (P<0.05). Continence at the first month after TRA-LRP was significantly higher than that after E-LRP (P<0.05). All patients recovered continence at 12 months after operation. None of the patients had biochemical recurrence during the follow-up.

Conclusions: Compared with E-LRP, TRA-LRP can reduce the blood loss and PSM rate in low-risk or intermediate-risk PCa, and may help patients regain early continence and potency after operation. It may be superior in reducing intraoperative risk, improving oncological outcomes, and early postoperative rehabilitation.

Keywords: Extraperitoneal; laparoscopic; prostatectomy; robot; transperitoneal.