ORIGINAL ARTICLE   Free access

Minerva Urology and Nephrology 2022 October;74(5):607-14

DOI: 10.23736/S2724-6051.22.04857-1

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Multicentric experience in Retzius-sparing robot-assisted radical prostatectomy performed by expert surgeons for high-risk prostate cancer

Antonio GALFANO ¹ ✉, Stefano TAPPERO ^{1, 2}, Christopher EDEN ³, Paolo DELL’OGLIO ¹, Karen FRANSIS ⁴, Hongqian GUO ⁵, Keith KOWALCZYK ⁶, Mattia LONGONI ¹, Rabii MADI ^{7, 8}, Koon H. RHA ⁹, Silvia SECCO ¹, Xuefeng QIU ⁵, Rashid SAYYID ⁷, Aldo M. BOCCIARDI ¹

¹ Unit of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; ² IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy; ³ Department of Urology, Royal Surrey County Hospital, Guildford, UK; ⁴ Department of Urology, UZA - University Hospital, Antwerp, Belgium; ⁵ Urology Department, Affiliated Drum Tower Hospital Medical School, Nanjing University, Nanjing, China; ⁶ Division of Urology, MedStar Georgetown University Hospital, Washington, DC, USA; ⁷ Division of Urology, Augusta University Medical Center, Medical College of Georgia, Augusta, GA, USA; ⁸ Urology and Robotic Surgery at Clemenceau Medical Center, Dubai, Arabian Emiorates; ⁹ Department of Urology, University of Seoul, Seoul, South Korea

BACKGROUND: The study aim was to report the results of Retzius-Sparing robot-assisted radical Prostatectomy (RSP) in high-risk prostate cancer (HR-PCa) patients in a multicentric setting of expert surgeons and to analyze predictors of positive surgical margins (PSMs) and urinary continence recovery.
METHODS: We retrospectively evaluated all consecutive HR-PCa patients who underwent RSP by expert surgeons in 7 centers. Pre-, peri- and postoperative features were collected. Minimum surgical experience required was 100 RSP cases. The oncological outcomes evaluated were PSMs and biochemical relapse (BCR). Urinary continence was defined as no pad or safety pad. Erectile function was defined as erections sufficient for intercourse.
RESULTS: We collected 579 patients operated by 9 surgeons. Median age was 66, median PSA was 9,6 ng/mL. ISUP biopsy was 1 in 3.8%, 2 in 23%, 3 in 32,6%, 4 in 19,9%, 5 in 20,7; median surgical time was 195 minutes. Pathological stage was pT2 in 40,1%, pT3a in 35,9%, pT3b in 23,1%, and pT4 in 0,9% of cases. PSMs were present in 31,3% of cases. Urinary continence was achieved in 66,8% of cases one week after catheter removal. At 22 months (median follow-up), 89,1% patients were continent, BCR occurred in 27,5% patients. In multivariate analysis, PSA, prostate volume, surgical time were independent predictors of PSMs; ASA score and PSMs predicted urinary continence.
CONCLUSIONS: We report the first multicentric experience of RSP for HR-PCa. Considering HR cases as those with the worst functional results, 89% of continent patients confirms that RSP helps achieve good functional results.

KEY WORDS: Prostatectomy; Robotics; Prostatic neoplasms