Functional and Oncological Outcomes Following Robot-Assisted and Laparoscopic Radical Prostatectomy for Localized Prostate Cancer With a Large Prostate Volume: A Retrospective Analysis With Minimum 2-Year Follow-Ups

ObjectiveWe aimed to analyze the perioperative, functional, and oncologic outcomes following robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) for patients with localized prostate cancer (PCa) characterized by a large prostate volume (PV; ≥50 ml) over a minimum of 2 years follow-up.Materials and MethodsPatients undergoing RARP and LRP for localized PCa with a large PV were included in the final analysis. The perioperative, functional, and oncologic outcomes were analyzed between the two groups.ResultsAll operations were successfully completed without open conversion in both groups. The mean operative time and estimated blood loss in the RARP group were significantly decreased compared to those in the LRP group (139.4 vs. 159.0 min, p = 0.001, and 124.2 vs. 157.3 ml, p = 0.003, respectively). Patients in the RARP arm had significantly lower proportions of grade II or lower and of higher than grade II postoperative complications compared with those in the LRP group (7.9% vs. 17.1%, p = 0.033, and 1.6% vs. 6.7%, p = 0.047, respectively). No significant differences in terms of the rates of pT3 disease, positive surgical margin, and positive lymph node were noted between the two groups. Moreover, no significant difference in the median specimen Gleason score was observed between the RARP and LRP groups (6 vs. 7, p = 0.984). RARP vs. LRP resulted in higher proportions of urinary continence upon catheter removal (48.4% vs. 33.3%, p = 0.021) and at 3 (65.1% vs. 50.5%, p = 0.025) and 24 (90.5% vs. 81.0%, p = 0.037) months post-operation. The median erectile function scores at 6 and 24 months post-operation in the RARP arm were also significantly higher than those in the LRP arm (15 vs. 15, p = 0.042, and 15 vs. 13, p = 0.026, respectively). Kaplan–Meier analyses indicated that the biochemical recurrence-free survival and accumulative proportion of continence were statistically comparable between the two groups (p = 0.315 and p = 0.020, respectively).ConclusionsFor surgically managing localized PCa with a large prostate (≥50 ml), RARP had a tendency toward a lower risk of postoperative complications and better functional preservation without cancer control being compromised when compared to LRP.

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A meta-analysis of robot assisted laparoscopic radical prostatectomy versus laparoscopic radical prostatectomy

Open Medicine ◽

10.1515/med-2019-0052 ◽

2019 ◽

Vol 14 (1) ◽

pp. 485-490 ◽

Cited By ~ 2

Author(s):

Tao Wang ◽

Qunsuo Wang ◽

Songtao Wang

Keyword(s):

Prostate Cancer ◽

Postoperative Complications ◽

Radical Prostatectomy ◽

Meta Analysis ◽

Surgical Margin ◽

Laparoscopic Radical Prostatectomy ◽

Localized Prostate Cancer ◽

Urinary Continence ◽

Robot Assisted ◽

Continence Rate

AbstractObjectiveTo evaluate the efficacy and safety of robot-assisted laparoscopic radical prostatectomy (RALP) and laparoscopic radical prostatectomy (LRP) for the treatment of localized prostate cancer.MethodsMeta-analysis was applied using Review Manager V5.3 software and the retrieved clinical trials comparing RALP with LRP for the treatment of localized prostate cancer published from 2000 to 2018 in PubMed, Ovid, ScienceDirect, and EMBASE datasets were analyzed.ResultsThis meta-analysis included 16 articles, totaling 7952 patients, with 5170 RALP patients and 2782 LRP patients. Meta-analysis showed that RALP postoperative complications were fewer (P=0.0007), and the postoperative urinary continence rate was better at 1 year after surgery (P<0.00001). There was no statistical significance between RALP and LRP with regards to the positive incidence of surgical margin (P = 0.18).ConclusionAs an emerging technology, RALP is superior to LRP for localized prostate cancer treatment in terms of postoperative complications, and postoperative urinary continence rate.

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

Frontiers in Oncology ◽

10.3389/fonc.2021.641887 ◽

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 > 0.05). The likelihood of transfusion, ≤Grade II, and >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.

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

10.21203/rs.3.rs-442704/v1 ◽

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.

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1029: Cancer to Total Prostate Volume Ratio Influences Patholgical Parameters and Biochemical Recurrence in Localized Prostate Cancer Treated by Radical Prostatectomy

The Journal of Urology ◽

10.1016/s0022-5347(18)31257-6 ◽

2007 ◽

Vol 177 (4S) ◽

pp. 340-340 ◽

Cited By ~ 1

Author(s):

Hong Gee Sim ◽

Donatello Telesca ◽

Stephen H. Culp ◽

Paul H. Lange ◽

William J. Ellis ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Prostate Volume ◽

Volume Ratio ◽

Localized Prostate Cancer

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Oncologic outcomes in prostate cancer patients treated with robot-assisted radical prostatectomy: results from a single institution series with more than 10 years follow up

Minerva Urologica e Nefrologica ◽

10.23736/s0393-2249.18.03285-x ◽

2019 ◽

Vol 71 (1) ◽

Cited By ~ 6

Author(s):

Lorenzo Bianchi ◽

Giorgio Gandaglia ◽

Nicola Fossati ◽

Alessandro Larcher ◽

Cristian Pultrone ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Cancer Patients ◽

Oncologic Outcomes ◽

Single Institution ◽

Robot Assisted

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Predictors of complications occurring after open and robot-assisted prostate cancer surgery: a retrospective evaluation of 1062 consecutive patients treated in a tertiary referral high volume center

Journal of Robotic Surgery ◽

10.1007/s11701-021-01192-w ◽

2021 ◽

Author(s):

Antonio Benito Porcaro ◽

Alessandro Tafuri ◽

Riccardo Rizzetto ◽

Nelia Amigoni ◽

Marco Sebben ◽

...

Keyword(s):

Prostate Cancer ◽

Postoperative Complications ◽

Radical Prostatectomy ◽

Blood Loss ◽

Open Approach ◽

Intraoperative Blood Loss ◽

Tertiary Referral ◽

Robot Assisted ◽

The Third ◽

Major Complications

AbstractTo investigate factors associated with the risk of major complications after radical prostatectomy (RP) by the open (ORP) or robot-assisted (RARP) approach for prostate cancer (PCa) in a tertiary referral center. 1062 consecutive patients submitted to RP were prospectively collected. The following outcomes were addressed: (1) overall postoperative complications: subjects with Clavien-Dindo System (CD) one through five versus cases without any complication; (2) moderate to major postoperative complications: cases with CD < 2 vs. ≥ 2, and 3) major post-operative complications: subjects with CDS CD ≥ 3 vs. < 3. The association of pre-operative and intra-operative factors with the risk of postoperative complications was assessed by the logistic regression model. Overall, complications occurred in 310 out of 1062 subjects (29.2%). Major complications occurred in 58 cases (5.5%). On multivariate analysis, major complications were predicted by PCa surgery and intraoperative estimated blood loss (EBL). ORP compared to RARP increased the risk of major CD complications from 2.8 to 19.3% (OR = 8283; p < 0.0001). Performing ePLND increased the risk of major complications from 2.4 to 7.4% (OR = 3090; p < 0.0001). Assessing intraoperative blood loss, the risk of major postoperative complications was increased by BL above the third quartile when compared to subjects with intraoperative blood loss up to the third quartile (10.2% vs. 4.6%; OR = 2239; 95%CI: 1233–4064). In the present cohort, radical prostatectomy showed major postoperative complications that were independently predicted by the open approach, extended lymph-node dissection, and excessive intraoperative blood loss.

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