Intermediate-term oncological and functional outcomes in prostate cancer patients treated with perineal robot-assisted radical prostatectomy: A single center analysis
Objective: In the last 10 years, robotic platforms allowed to resume of some alternative surgical approaches, including perineal robot-assisted radical prostatectomy (p-RARP). Herein, we present in detail the oncological and functional outcomes of patients who underwent p-RARP with a median follow-up of 30 months.
Methods: Patients presenting low- or intermediate-risk prostate cancer and prostate volume up to 60 mL who underwent p-RARP between November 2018 and November 2022 were selected. Baseline, intraoperative, pathological, and postoperative data were collected and then analyzed.
Results: Thirty-seven p-RARP cases were included. Such patients presented mean age of 62 years and a mean Charlson comorbidity index of 4. Body mass index of ≥25 kg/m2 was reported by 24 (64.9%) patients, as well as 7 (18.9%) patients reported a past surgical history. Mean prostate volume and median prostate-specific antigen were 41 mL and 6.2 ng/mL, respectively. The median operative time was 242 min. The positive surgical margin rate was 45.9%. In terms of postoperative complications, 10 patients reported complications with any grade; however, a single case (2.7%) of major (Clavien-Dindo grade ≥3) complication was observed. No patient with biochemical recurrence or distant metastasis was reported at 2 years of follow-up. Recovery of continence rates were 67.6%, 75.7%, and 92.9%, at 6 months, 12 months, and 24 months after surgery, respectively.
Conclusion: p-RARP is a challenging but safe minimally invasive approach for selected patients with prostate cancer suitable for radical prostatectomy, showing outstanding functional recovery. Despite positive surgical margin rates being relatively high, no cases of biochemical recurrence or distant metastasis were reported after a median follow-up of 30 months.
. [J]. Asian Journal of Urology, 2023, 10(4): 423-430.
Umberto Carbonara, Giuseppe Lippolis, Luciano Rella, Paolo Minafra, Giuseppe Guglielmi, Antonio Vitarelli, Giuseppe Lucarelli, Pasquale Ditonno. Intermediate-term oncological and functional outcomes in prostate cancer patients treated with perineal robot-assisted radical prostatectomy: A single center analysis. Asian Journal of Urology, 2023, 10(4): 423-430.
Concordance of PSM and site of index lesion at mpMRI
Yes
7 (41.2)
No
6 (35.3)
Unknown
4 (23.5)
LVI
4 (10.8)
Oncological and functional outcomes
Value
PSA, ng/mL
Postop 6 mo
0.02 (0.01-0.03)
Postop 12 mo
0.04 (0.03-0.05)
Postop 24 mo
0.04 (0.02-0.06)
BCR at 24 moa,b
0 (0)
Metastasis at 24 moa
0 (0)
Recovery of erectile function (according to IIEF-5)c
Postop 6 mo
24 (64.9)
Postop 12 mo
29 (78.4)
Postop 24 moa
23 (82.1)
Recovery of continenced
Postop 6 mo
25 (67.6)
Postop 12 mo
28 (75.7)
Postop 24 moa
26 (92.9)
Study
Robotic platform
n
F/U, month
Prostate volume, mL
OPT, min
Nerve-sparing, %
LOS, day
Catheterization time, day
PSM, %
Continence, %
Major complication, %
Tu?cu et al. 2020 [11]
Xi?
95
13
52
140
100
1
7
8
91a
11
Lenfant et al. 2021 [25]
Sp?
26
12.4
30
255
62.5
1
11
65.4
80.1a
23
Current
Xi?
37
30
42
252
83.7
2
9
47.3
92b
2.7
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