NARUS 2018: Short Term Functional and Oncological Outcomes of Retzius-Sparing Robotic Radical Prostatectomy in High-Risk Prostate Cancer
Between May 2016 and September 2017, 160 patients underwent retzius-sparing robotic prostatectomy. Among these patients, 55 (34%) had high-risk prostate cancer according to D’Amico risk classification and had extended pelvic lymphadenectomy. These patients were matched to 55 high-risk patients undergoing non-retzius sparing robotic prostatectomy by the same robotic surgeon to assess: post-operative complications, functional outcomes, positive margin rate, and biochemical recurrence.
Both groups were well matched with no differences in age, BMI, PSA, Gleason score, or clinical stage. There was also no difference with respect to operative time, blood loss, conversion rate (0 for both groups), transfusion rate (0 for both groups), prostate weight, or lymph node yield. The mean follow-up for the retzius sparing robotic prostatectomy group was 8 months (range 1-16 months) and 24 months (range 16-33) for the non-retzius sparing robotic prostatectomy group. There were two non-retzius sparing robotic prostatectomy group Clavien grade III complications, as well as two in the retzius sparing robotic prostatectomy group. The median duration of catheterization was shorter for the retzius sparing robotic prostatectomy group (9 vs 14 days, p<0.001), of which 71% had a suprapubic catheter inserted at the time of surgery. Furthermore, there was no difference in positive surgical margin rate between the two groups (31% retzius vs 40% non-retzius, p=0.43), nor biochemical recurrence rate (5.5% each group, p=1.00). Patients undergoing retzius sparing robotic prostatectomy had significantly higher 4-week pad-free rates of 72.7% vs 7.3% (p<0.001).
The authors concluded that men undergoing retzius sparing robotic prostatectomy have a significant improvement in urinary continence rates at 4 weeks in high-risk patients as compared to non-retzius sparing robotic prostatectomy. However, as they note, longer follow-up is necessary to assess the impact of this approach on oncologic outcomes.
Presented By: Venkata R.M. Kusuma, Dapartment of Urology, Royal Surrey County Hospital, Guildford, UK
Co-Authors: Pavlos Pavlakis, Dimitrios Moschanos, Christopher Eden
Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, @zklaassen_md ,at the 2018 North American Robotic Urology Symposium, February 16-17, 2018 - Las Vegas, NV
References:
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