Differences in Patient Characteristics among Men Choosing Open or Robot-Assisted Radical Prostatectomy in Contemporary Practice - Analysis of Surveillance, Epidemiology, and End Results Database

Abstract Aim Salvage Robot-Assisted Radical Prostatectomy (sRARP) is a potential treatment option for locally recurrent Prostate Cancer after non-surgical primary treatment. There are minimal data comparing outcomes between propensity-matched salvage and primary Robot-Assisted Radical Prostatectomy (RARP). We compare perioperative, oncological, and functional outcomes of sRARP with primary RARP and between sRARP post-whole and focal gland therapy. Method 1:1 propensity-matched comparison of 146 sRARP with primary RARP from a cohort of 3,852 consecutive patients from a high-volume tertiary centre. Results There were no significant differences in patient characteristics between the salvage and primary RARP groups. Grade III-V Clavien-Dindo complication rates were 1.3% and 0% in the salvage and primary groups, respectively (p = 0.310). Median (IQR) follow-up was 16 (10,30) and 21 (13,33) months in the salvage and primary groups, respectively. BCR rates were 30.8% and 13.7% in the salvage and primary groups, respectively (p < 0.001). Pad-free continence rates were 79.1% and 85.4% at two years in the salvage and primary groups, respectively (p = 0.160). ED rates were 95.2% and 77.4% in the salvage and primary groups, respectively (p < 0.001). Comparing the whole gland and focal gland groups, BCR rates were 33.3% and 29.1%, respectively (p = 0.687), pad-free continence rates were 66% and 89.3%, respectively (p = 0.001), and ED rates were 98.3% and 93%, respectively (p = 0.145). Conclusions SRARP has similar perioperative but inferior oncological outcomes to primary RARP. Continence rates are similar to primary RARP, but potency is worse. Perioperative and oncological outcomes of sRARP after focal gland therapy are similar but continence outcomes are superior compared to sRARP after whole gland therapy.

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Risks and complications of robot-assisted radical prostatectomy (RARP) in patients receiving antiplatelet and/or anticoagulant therapy: a retrospective cohort study in a single institute

Journal of Robotic Surgery ◽

10.1007/s11701-020-01154-8 ◽

2020 ◽

Author(s):

Masashi Oshima ◽

Satoshi Washino ◽

Yuhki Nakamura ◽

Tsuzumi Konishi ◽

Kimitoshi Saito ◽

...

Keyword(s):

Radical Prostatectomy ◽

Blood Loss ◽

Postoperative Bleeding ◽

Patient Characteristics ◽

Bleeding Complications ◽

Control Group ◽

Control Groups ◽

Robot Assisted ◽

Estimated Blood Loss ◽

Significant Difference

Abstract The objective of the study was to evaluate the risk of bleeding complications in patients undergoing robot-assisted radical prostatectomy (RARP) while taking antiplatelet (AP) and/or anticoagulant (AC) agents. We analyzed the data of 334 patients undergoing RARP from May 2015 to May 2019. Patients were categorized into AP, AC, and control groups; the bleeding complications were compared among them. The end points were the estimated blood loss, decrease in hemoglobin level, and bleeding complications. The patient characteristics did not differ significantly among groups, with the exception of ASA scores, which were significantly higher in the AP and AC groups vs. the control group. The estimated blood loss and hemoglobin decrease were not significantly different between the AP and AC groups and the control group. The frequency of bleeding complications did not differ significantly between the AP and the control groups, but was significantly higher in the AC vs. the control group (4.3% in the AP and 23.5% in the AC group vs. 3.7% in the control group; P = 0.63 and P < 0.01, respectively). There was no significant difference in bleeding complications between the AP continuation (continuation of a single AP) and the AP interruption group or between the heparin bridging and the AC interruption group. All bleeding complications observed in the AC group occurred after resuming AC therapy. RARP can be performed safely with continuation of a single AP, and in patients taking ACs by interrupting these agents or via heparin bridging, without increasing intraoperative bleeding, whereas postoperative bleeding complications may increase after resuming ACs.

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Salvage versus primary robot-assisted radical prostatectomy: a propensity-matched comparative effectiveness study from a high-volume tertiary centre

10.7244/cmj.2021.04.001.7 ◽

2021 ◽

Author(s):

Arjun Nathan ◽

Monty Fricker ◽

Ruben De Groote ◽

Amandeep Arora ◽

Yuzhi Phuah ◽

...

Keyword(s):

Radical Prostatectomy ◽

High Volume ◽

Patient Characteristics ◽

Primary Treatment ◽

Complication Rates ◽

Risk Propensity ◽

Robot Assisted ◽

Oncological Outcomes ◽

Tertiary Centre ◽

Primary Groups

Introduction Salvage Robot-Assisted Radical Prostatectomy (sRARP) is a potential treatment option for locally recurrent Prostate Cancer after non-surgical primary treatment. There are minimal data comparing outcomes between similar-risk, propensity-matched salvage and primary Robot-Assisted Radical Prostatectomy (RARP). We compare perioperative, oncological and functional outcomes of sRARP with primary RARP and between sRARP post-whole and focal gland therapy. Methods 1:1 propensity-matched comparison of 146 sRARP with primary RARP from a cohort of 3,852 consecutive patients from a high-volume tertiary centre. Results There were no significant differences in patient characteristics between the salvage and primary RARP groups. Grade III-V Clavien-Dindo complication rates were 1.3% and 0% in the salvage and primary groups (p=0.310). Median (IQR) follow-up was 16 (10, 30) and 21 (13, 33) months in the salvage and primary groups. BCR rates were 30.8% and 13.7% in the salvage and primary groups (p<0.001). Pad-free continence rates were 79.1% and 85.4% at two years in the salvage and primary groups (p=0.160). Erectile dysfunction was 95.2% and 77.4% in the salvage and primary groups (p<0.001). On comparison of whole and focal gland groups, biochemical recurrence was 33.3% and 29.1% (p=0.687), pad-free continence rates were 66% and 89.3% (p=0.001), and ED rates were 98.3% and 93% (p=0.145). Conclusions SRARP has similar perioperative but inferior oncological outcomes to primary RARP. Continence rates are similar to primary RARP, but potency is worse. Perioperative and oncological outcomes of sRARP after focal gland therapy are similar compared to after whole gland therapy but continence outcomes are superior.

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