Robot-Assisted Radical Prostatectomy in Renal Transplant Recipients: A Systematic Review.

Robot-assisted radical prostatectomy (RARP) has been shown to achieve excellent oncological outcomes with a low rate of complications in patients with prostate cancer. However, data on RARP in renal transplant recipients (RT) are dispersed. A literature search was conducted through April 2023 using PubMed/Medline, Embase and Web of Science databases. The primary aim was to evaluate the safety, oncologic and clinical outcomes of RARP in RT recipients. The secondary aim was to identify surgical technique modifications required to avoid iatrogenic damage to the transplanted kidney. A total of 18 studies comprising 186 patients met the inclusion criteria. Age at the time of treatment ranged 43-79 years. Biopsy results showed a high prevalence of low- and intermediate-risk disease. Operative time ranged between 108.3 and 400 mins, while estimated blood loss ranged from 30 to 630 mL. Length of hospital stay ranged from 3 to 6 days whereas duration of catheterization was between 5 and 18 days. Perioperative complication rate was 17.1%. Overall positive surgical margin rate was 24.19%, while biochemical recurrence was observed in 10.21% (19/186 patients). Modifications to the standard surgical technique were described in 13/18 studies. Modifications in port placement were described in 7/13 studies and performed in 19/88 (21.6%) patients. Surgical technique for the development of the Retzius space was reported in 13/18 studies. Data on lymphadenectomy were reported in 15/18 studies. Bilateral lymphadenectomy was described in 3/18 studies and performed in 4/89 (4.5%) patients; contralateral lymphadenectomy was reported in 7/18 studies and performed in 41/125 (32.8%) patients. RARP in RTRs can be considered relatively safe and feasible. Oncological results yielded significantly worse outcomes in terms of PSM and BCR rate compared to the data available in the published studies, with an overall complication rate highly variable among the studies included. On the other hand, low graft damage during the procedure was observed. Main criticisms came from different tumor screening protocols and scarce information about lymphadenectomy techniques and outcomes among the included studies.

Journal of clinical medicine. 2023 Oct 25*** epublish ***

Alberto Piana, Alessio Pecoraro, Flavio Sidoti, Enrico Checcucci, Muhammet İrfan Dönmez, Thomas Prudhomme, Beatriz Bañuelos Marco, Alicia López Abad, Riccardo Campi, Romain Boissier, Michele Di Dio, Francesco Porpiglia, Alberto Breda, Angelo Territo, EAU Young Academic Urologists (YAU) Working Group on Kidney Transplantation

Department of Urology, University of Turin, 10043 Turin, Italy., Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy., Department of Urology, Romolo Hospital, 88821 Rocca di Neto, Italy., Department of Surgery, Candiolo Cancer Institute FPO-IRCCS, Candiolo, 10060 Turin, Italy., Department of Urology, İstanbul Faculty of Medicine, İstanbul University, 34093 İstanbul, Turkey., Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, 31400 Toulouse, France., Division Renal Transplantation and Reconstructive Urology, Hospital Universitario El Clínico San Carlos, 28040 Madrid, Spain., Department of Urology and Renal Transplantation, La Conception University Hospital, 13005 Marseille, France., Division of Urology, Department of Surgery, Annunziata Hospital, 87100 Cosenza, Italy., Unit of Uro-oncology and Kidney Transplant, Department of Urology, Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), 08025 Barcelona, Spain.