scholarly journals Robot-Assisted vs. Laparoscopic Radical Prostatectomy for Immediate- and High-Risk Localized Prostate Cancer: A Propensity-Score Matched Analysis

2021 ◽  
Author(s):  
Deng Wen ◽  
Zhang Cheng ◽  
Jiang Hao ◽  
Li Yulei ◽  
Liu Xiaoqiang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Propensity Score ◽  
Lower Risk ◽  
Laparoscopic Radical Prostatectomy ◽  
Localized Prostate Cancer ◽  
Robot Assisted ◽  
Grade Ii

Abstract Background To evaluate the functional and oncological efficacy of robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) for immediate- and high-risk localized prostate cancer (PCa). Methods 232 patients bearing immediate- and high-risk localized PCa between January 2016 and October 2019 were enrolled according to the inclusion criteria. The perioperative, functional and oncological outcomes were compared between the RARP and LRP groups after applying the propensity-score matching (PM) (1:1) method, which were employed to attenuate the impact of the potential baseline confounders. Results In all, except for 10 patients without a suitable pair, the remaining patients in the LRP group were successfully matched to 85 patients in the RARP arm. All differences in preoperative variables turned to be insignificant after PM. Within the matched cohort, no open conversion was required in both groups. The RARP group was corrected with a significantly shorter mean operative time than the LRP group (p < 0.001). Patients in the RARP arm were also at a lower risk of ≤ Grade II complications than those in the LRP group (p = 0.036). Meanwhile, the proportions of transfusion and ≥ Grade II complications in the RARP group were similar to that in the LRP group (p = 0.192 and p = 1.000, respectively). No significant differences regarding the mean estimated blood loss, rates of pT3 disease and positive surgical margin, median specimen Gleason score and hospital stay length existed between the two groups. RARP vs. LRP tended to a significantly higher percentage of urinary continence at the removal of catheter (p = 0.031), postoperative 6 months (p = 0.043), and last follow-up (p = 0.046). Significant differences were also found between the RARP and LRP arms in erectile function at postoperative 6 months and last follow-up (p = 0.013 and p = 0.009, respectively). The statistical comparability between the two groups was observed in biochemical recurrence-free survival (p = 0.228). Conclusions For surgically managing immediate- and high-risk localized PCa, RARP tended to a lower risk of ≤ Grade II complications and superior functional preservation without cancer control being compromised when comparing with LRP.

scholarly journals Functional Preservation and Oncologic Control following Robot-Assisted versus Laparoscopic Radical Prostatectomy for Intermediate- and High-Risk Localized Prostate Cancer: A Propensity Score Matched Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Wen Deng ◽  
Ru Chen ◽  
Ke Zhu ◽  
Xiaofeng Cheng ◽  
Yunqiang Xiong ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Propensity Score ◽  
Lower Risk ◽  
Cancer Control ◽  
Robot Assisted ◽  
Grade Ii ◽  
Functional Preservation

Aim. To evaluate the urinary continence (UC), erectile function, and cancer control obtained following robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) for intermediate- and high-risk localized prostate cancer (PCa). Materials and Methods. 232 patients bearing intermediate- and high-risk localized PCa were enrolled in this study. Perioperative, functional, and oncological outcomes were analyzed after applying the propensity score matched method. Results. Within the matched cohort, the RARP group was corrected with a significantly shorter mean operative time than the LRP group ( p  < 0.001). Patients in the RARP arm were also at a lower risk of ≤ Grade II complications than those in the LRP group ( p  = 0.036). Meanwhile, the proportions of transfusion and ≥ Grade II complications in the RARP group were similar to those in the LRP group ( p  = 0.192 and p  = 1.000, respectively). No significant differences regarding the rates of pT3 disease and positive surgical margin existed between the two groups. RARP versus LRP tended to a significantly higher percentage of UC recovery within the follow-up period. Significant differences were also found between the RARP and LRP arms in terms of erectile function at postoperative 6 months and the last follow-up ( p  = 0.013 and p  = 0.009, respectively). Statistical comparability in biochemical recurrence-free survival was observed between the two groups ( p  = 0.228). Conclusions. For the surgical management of intermediate- and high-risk localized PCa, RARP tended to a lower risk of ≤ Grade II complications and superior functional preservation without cancer control being compromised than LRP.

scholarly journals Retzius-sparing robot-assisted laparoscopic radical prostatectomy: functional and early oncologic results in aggressive and locally advanced prostate cancer

BMC Urology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Joanne Nyaboe Nyarangi-Dix ◽  
Magdalena Görtz ◽  
Georgi Gradinarov ◽  
Luisa Hofer ◽  
Viktoria Schütz ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Postoperative Radiotherapy ◽  
Locally Advanced ◽  
Laparoscopic Radical Prostatectomy ◽  
Oncologic Outcomes ◽  
Robot Assisted

Abstract Background Retzius-sparing robot-assisted laparoscopic radical prostatectomy (rsRARP) allows entire prostatectomy procedure via the pouch of Douglas. In low- and intermediate-risk prostate cancer (PCa) there is level 1 evidence that the Retzius-sparing approach impacts early continence recovery. Since specific data on aggressive and locally advanced cancer is lacking and avoiding rsRARP is presently suggested, we investigated urinary and sexual recovery, perioperative complications and early oncologic outcomes after rsRARP in this particular cohort. Methods Prospectively collected data of 50 consecutive men (median age 66 years) with high-risk PCa who underwent rsRARP in a single institution was analysed retrospectively. The follow-up for all patients was 12 months after surgery. Results 3 vs. 12 months after surgery, 82% vs. 98% of men used no pad or one safety pad and 50% vs. 72% used no pad. 89% of patients did not observe a decline of continence if postoperative radiotherapy was carried out. Considering the 17 preoperatively potent patients who underwent bi- or unilateral nerve-sparing surgery, 41% reported their first sexual intercourse within 1 year after rsRARP. 84% of patients had ≥pT3a disease and 42% positive surgical margins. A lymphadenectomy was done in 94% of patients with a median lymph node removal of 15 and lymph node metastasis in 13%. 34% underwent adjuvant radiotherapy and 22% adjuvant androgen deprivation therapy (ADT). 1-year recurrence-free survival was 96%, including 25% of patients on adjuvant or salvage ADT. Conclusions RsRARP in high-risk PCa is feasible and results in excellent continence rates, even after postoperative radiotherapy. The potency rates are promising but need further clarification in larger cohorts. Reliable oncologic outcomes require longterm follow-up and are awaited.

scholarly journals Transvesical Versus Posterior Approach to Retzius-Sparing Robot-Assisted Radical Prostatectomy: A Retrospective Comparison With a 12-Month Follow-Up

2021 ◽  
Vol 11 ◽  
Author(s):  
Wen Deng ◽  
Cheng Zhang ◽  
Hao Jiang ◽  
Yulei Li ◽  
Ke Zhu ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Erectile Function ◽  
Localized Prostate Cancer ◽  
Robot Assisted ◽  
Open Conversion ◽  
Estimated Blood Loss ◽  
Before And After ◽  
Grade Ii

ObjectivesTo assess the perioperative, functional, and oncological outcomes of transvesical robot-assisted radical prostatectomy (T-RARP) and posterior robot-assisted radical prostatectomy (P-RARP) for localized prostate cancer.Materials and MethodsWe analyzed the data of 96 patients who underwent T-RARP or P-RARP for localized prostate cancer between January 2017 and June 2019 in a retrospective fashion.ResultsNo significant differences in the baseline characteristics existed between the T-RARP and P-RARP arms. Both interventions were successfully performed without open conversion in either group. T-RARP was associated with a slightly more operative time (135.3 vs. 127.3 min) and estimated blood loss (105.2 vs. 94.2 mL) than P-RARP, but the differences were not significant (both p &gt; 0.05). The likelihood of transfusion, ≤Grade II, and &gt;Grade II postoperative complications, pT3a disease and positive surgical margins in the T-RARP group was comparable with that in the P-RARP group. No significant differences were noted between these two arms in terms of UC at the removal of catheter and nocturia (p = 0.750 and p = 0.684, respectively), and all included patients recovered UC at 3 months postoperatively. The median International Index of Erectile Function-5 score in both groups remains comparable before and after RARP. The patients in the T-RARP and P-RARP groups had a similar biochemical recurrence-free survival (p = 0.387).ConclusionsBoth T-RARP and P-RARP by experienced hands are feasible for well-selected patients with prostate cancer, obtaining similar outcomes in terms of perioperative results, UC and erectile function, and oncological control within short-term follow-up.

Comparison of Treatment Outcomes between Laparoscopic and Robot-Assisted Laparoscopic Radical Prostatectomy in Clinically Localized Prostate Cancer, A Single-Surgeon Experience

2020 ◽  
Vol 103 (12) ◽  
pp. 1300-1308
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Laparoscopic Radical Prostatectomy ◽  
Localized Prostate Cancer ◽  
Robot Assisted ◽  
Oncological Outcomes ◽  
Estimated Blood Loss ◽  
Surgeon Experience ◽  
Potency Rate

Objective: To compare the treatment outcomes between laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic radical prostatectomy (RALP) in clinically localized prostate cancer in a tertiary care hospital in Thailand by a single-surgeon experience. Materials and Methods: Between January 2013 and June 2019, 171 patients with clinically localized prostate cancer underwent minimally invasive radical prostatectomy. These were LRP in 62 patients and RALP in 109 patients. All clinical data were retrospectively reviewed. Patient demographic data, perioperative parameters, pathological reports, oncological outcomes, and functional outcomes including continence and potency rate at 1, 3, 6, and 12 months were compared between groups. Results: Patients in the RALP group were significantly younger (p=0.03) and had a shorter follow-up period (p=0.004). The estimated blood loss was significantly lower in the RALP group (p=0.001). There were no significant differences in intraoperative and 30-day postoperative complications. Pathological results and overall positive surgical margin rate (PSM) were not significantly different. In pT3 patients, PSM was significantly lower in the RALP group (p=0.045). Oncological outcomes were not different in term of biochemical recurrence (BCR) rate (p=0.3), median time to BCR (p=0.45), BCR-free survival (p=0.81), and overall survival (p=0.99). The continence rate was significantly better in the RALP group in every period after surgery (p=0.01, <0.001, 0.001, and p=0.02 at 1, 3, 6 and 12 months, respectively). The potency rate who performed bilateral neurovascular bundles sparing was not different between groups. Conclusion: RALP provided a significant improvement of continence recovery and PSM rate in non-organ confined disease. Estimated blood loss was significantly lower among the RALP patient. Larger numbers of patients with longer follow-up will justify proofing these findings. Keywords: Laparoscopic surgery, Robot-assisted surgery, Radical prostatectomy, Prostate cancer

Effect of open versus robot-assisted laparoscopic radical prostatectomy on cancer control in patients with clinically localized prostate cancer: Prospective analysis of 1,014 consecutive patients.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 80-80
Author(s):  
Adrian Stuart Fairey ◽  
Niels Jacobsen ◽  
Don Voaklander ◽  
Eric Estey
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Surgical Approach ◽  
Biochemical Recurrence ◽  
Cancer Control ◽  
Laparoscopic Radical Prostatectomy ◽  
Localized Prostate Cancer ◽  
Prospective Analysis ◽  
Robot Assisted

80 Background: There are limited prospective data comparing outcomes of Open Radical Prostatectomy (ORP) and Robot-Assisted Laparoscopic Radical Prostatectomy (RALRP) for clinically localized prostate cancer. Our aim was to compare ORP and RALRP with respect to cancer control outcomes. Methods: A prospective analysis of data from the University of Alberta Radical Prostatectomy Database was performed. Between September 2007 and August 2010, 1019 consecutive men underwent radical prostatectomy for clinically localized prostate cancer. The surgical approach was selected by the surgeon. The outcomes were biochemical recurrence (BCR) and positive surgical margins (PSM). BCR was defined as a PSA ≥ 0.1 ng/ml followed by a subsequent confirmatory value or initiation of salvage therapy. PSM was defined as the presence of cancer at the inked margin in the radical prostatectomy specimen. The Kaplan-Meier method was used to estimate biochemical recurrence free survival (BCRFS). Univariable and multivariable analyses were used to determine the association between surgical approach and outcomes. Results: Data were evaluable for 1014 out of 1019 patients. 204 patients underwent ORP and 810 patients underwent RALRP. The median follow-up duration was 21 months (IQR 12 to 29). Baseline characteristics were similar between the groups. In univariable analysis, 3-year BCRFS (90.6% versus 88.9%), overall PSM (26.5% versus 28.8%), and stage-stratified PSM (pT2: 19.9% versus 21.8%; pT3: 40.6% versus 49.1%) did not differ between the groups (all comparisons p>0.05). In multivariable analysis, surgical approach was not independently associated with BCR (HR 0.77, 95% CI 0.43 to 1.37, p=0.37) or PSM (OR 1.2, 95% CI 0.80 to 1.67, p=0.44). Conclusions: ORP and RALRP provided comparable short-term oncologic efficacy. Extended follow-up of the prospective cohort is needed to confirm these preliminary findings.

scholarly journals Salvage robot-assisted radical prostatectomy (sRARP) for radiation resistant prostate cancer in a group of initially high risk patients

2017 ◽  
Vol 1 (1) ◽  
pp. 21-27
Author(s):  
Nirmal Lamichhane ◽  
Adam S. Dowrick ◽  
Ulrika Axcrona ◽  
Bjørn Brennhovd ◽  
Sophie D. Fosså ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
High Frequency ◽  
Salvage Treatment ◽  
Rectal Injury ◽  
Robot Assisted ◽  
Radiation Resistant ◽  
Risk Patients

Introduction: Salvage robot-assisted radical prostatectomy (sRARP) is seen as an attractive option for salvage treatment of radiation therapy -recurrent prostate cancer (PC), thanks in part to the good visualisation that is possible using this modality. However, the results of fewer than 200 salvage sRARPs have been published in the literature. We report the outcomes in a cohort of initially high risk patients of robot-assisted radical prostatectomy as salvage local therapy for radiation-resistant PC in a Scandinavian healthcare setting. Materials and methods: A retrospective review of the charts of all patients who underwent sRARP for biochemical failure (BCF) after primary radiation treatment for localised PC at a single institution was performed. Results: Twenty-two patients, median age 67 years (range 57 to 72), had sRARP performed between June 2008 to July 2013. A median follow-up of 26 months (range 2 to 63) was observed. Perioperative complications occurred in 4 patients (18%), with one patient sustaining a rectal injury. Histo-pathological diagnosis was pT2 in three, pT3a in five, pT3b in twelve and pTx in one patient. Ten patients (45%) had a positive surgical margin (PSM). At follow-up, 54 % of patients were free of biochemical progression and 41% were continent. Conclusions: We showed that salvage RARP is technically feasible in a cohourt of patients with predominantly high risk disease. This study adds to the limited data already in the literature, demonstrating the high frequency of locally advanced (pT3b) PC, a patient group that is usually not included in salvage treatments, as e.g. high frequency ultrasound or salvage brachytherapy. Further, given that the historical barriers to salvage RP with higher rates of rectal injury and poor urinary control no longer seem to be applicable in the modern era, we think that more patients should be considered candidates for this potentially curative salvage treatment of radiation-resistant PC. However, long-term follow-up is needed to confirm if the additional burden on these patients confers to oncological control following the procedure.

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