Is It Safe to Switch from a Standard Anterior to Retzius-Sparing Approach in Robot-Assisted Radical Prostatectomy?
Abstract
1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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SA-RARP (N = 100) | RS-RARP (N = 100) | p | ||
---|---|---|---|---|
Age (years) | 67 (62–73) | 66 (61–70) | 0.166 | |
BMI (kg/m²) | 26.3 (24.1–28.5) | 26.3 (24.3–29.0) | 0.713 | |
ASA-score | 2 (2–2) | 2 (2–2) | 0.766 | |
Prostate volume (mL) | 45 (34–56) | 44 (34–65) | 0.756 | |
PSA (ng/mL) | 8.62 (6.16–10.79) | 7.38 (5.37–10.60) | 0.09 | |
Previous prostate surgery | 0.009 | |||
None | 91 (91%) | 100 (100%) | ||
TURP | 8 (8%) | 0 (0%) | ||
Other | 1 (1%) | 0 (0%) | ||
Biopsy ISUP Grade Group | 0.176 | |||
1 | 18 (18%) | 15 (15%) | ||
2 | 35 (35%) | 34 (34%) | ||
3 | 19 (19%) | 32 (32%) | ||
4 | 15 (15%) | 13 (13%) | ||
5 | 13 (13%) | 6 (6%) | ||
cT | 0.005 | |||
T1c | 26 (26%) | 39 (39%) | ||
T2 | 30 (30%) | 29 (29%) | ||
T3 | 3 (3%) | 12 (12%) | ||
T4 | 1 (1%) | 0 (0%) | ||
Missing | 39 (39%) | 18 (18%) | ||
cN | 0.32 | |||
N0 | 94 (94%) | 98 (98%) | ||
N1 | 3 (3%) | 2 (2%) | ||
Nx | 2 (2%) | 0 (0%) | ||
Missing | 1 (1%) | 0 (0%) | ||
cM | 0.059 | |||
M0 | 66 (66%) | 78 (78%) | ||
Mx | 34 (34%) | 22 (22%) | ||
MRI | 0.063 | |||
PIRADS 1–2 | 4 (4%) | 9 (9%) | ||
PIRADS 3 | 12 (12%) | 13 (13%) | ||
PIRADS 4–5 | 78 (78%) | 77 (77%) | ||
Not performed/Missing | 6 (6%) | 1 (1%) | ||
iT | 0.155 | |||
T2 | 70 (70%) | 63 (63%) | ||
T3 | 18 (18%) | 26 (26%) | ||
No tumor | 4 (4%) | 10 (10%) | ||
Not performed/missing | 8 (8%) | 1 (1%) | ||
Index Lesion Location | <0.001 | |||
Peripheral zone | 63 (63%) | 83 (83%) | ||
Anterior zone | 20 (20%) | 4 (4%) | ||
Multifocal (anterior and posterior) | 5 (5%) | 2 (2%) | ||
No MRI or no index lesion | 12 (12%) | 11 (11%) |
SA-RARP (N = 100) | RS-RARP (N = 100) | p | ||
---|---|---|---|---|
Surgeon | <0.001 | |||
NL | 96 (96%) | 71 (71%) | ||
CVP | 4 (4%) | 28 (28%) | ||
Missing | 0 (0%) | 1 (1%) | ||
Operative time (mins) | 147.5 (125–175) | 160 (145–180) | 0.005 | |
Estimated blood loss (mL) | 400 (150–400) | 225 (100–300) | 0.096 | |
Positive lymph nodes | 0 (0–0) | 0 (0–0) | <0.001 | |
Nerve-sparing (%) | 0.005 | |||
None | 9 (9%) | 6 (6%) | ||
Unilateral | 22 (22%) | 43 (43%) | ||
Bilateral | 69 (69%) | 50 (50%) | ||
Missing | 0 (0%) | 1 (1%) | ||
Intraoperative leak test | 0.028 | |||
No leakage | 93 (93%) | 82 (82%) | ||
Leakage | 7 (7%) | 17 (17%) | ||
Missing | 0 (0%) | 1 (1%) | ||
Duration of urinary catheter stay (days) | 3 (3–3) | 3 (3–3) | 0.382 | |
Length of stay (days) | 3 (3–3) | 3 (3–3) | 0.268 |
Clavien-Dindo | SA-RARP (N = 100) | RS-RARP (N = 100) | p | |||
---|---|---|---|---|---|---|
0 | 79 | 88 | 0.028 | |||
1 | 12 | Urinary retention (11) Abdominal wall hematoma (1) | 9 | Urinary retention (7) Prolonged suprapubic pain (1) Prolonged hematuria (1) | ||
2 | 9 | Wound infection (1) Urinary tract infection (7) Anastomotic leakage (1) | 1 | Infected lymfocele (1) | ||
3A | 0 | 1 | Infected lymfocele (1) | 0.292 | ||
3B | 4 | Cholecystitis (1) Hemoperitoneum (1) Anastomotic leakage (1) Obstructive pyelonephritis (1) | 1 | Gastrointestinal obstruction (1) | ||
4A | 1 | Hypovolemic shock (1) | 0 | |||
4B | 1 | Urosepsis (1) | 0 |
SA-RARP (N = 100) | RS-RARP (N = 100) | p | |||
---|---|---|---|---|---|
Preoperative potency (N = 200) | <0.001 | ||||
Impotent | 31 (31%) | 27 (27%) | |||
Potent | 48 (48%) | 63 (63%) | |||
Missing | 21 (21%) | 9 (9%) | |||
Postoperative potency in preoperatively potent men (N = 111) | 0.608 | ||||
Impotent | 21 (44%) | 25 (40%) | |||
Potent | 25 (52%) | 37 (59%) | |||
Missing | 2 (4%) | 1 (1%) | |||
Pathology T stage | 0.38 | ||||
T2 | 52 (52%) | 51 (51%) | |||
T3a | 32 (32%) | 38 (38%) | |||
T3b | 16 (16%) | 10 (10%) | |||
Missing | 0 (0%) | 1 (1%) | |||
Pathology N stage | <0.001 | ||||
pN0 | 49 (49%) | 34 (34%) | |||
pN1 | 10 (10%) | 0 (0%) | |||
pNx | 41 (41%) | 65 (65%) | |||
Missing | 0 (0%) | 1 (1%) | |||
Pathology ISUP Grade Group | 0.344 | ||||
1 | 5 (5%) | 5 (5%) | |||
2 | 43 (43%) | 41 (41%) | |||
3 | 24 (24%) | 34 (34%) | |||
4 | 13 (13%) | 6 (6%) | |||
5 | 15 (15%) | 13 (13%) | |||
Missing | 0 (0%) | 1 (1%) | |||
Surgical margins | |||||
T2 | R0 | 44 (84.6%) | 39 (76.5%) | 0.329 | |
R1 | 8 (15.4%) | 12 (23.5%) | |||
T3 | R0 | 27 (56.3%) | 17 (35.4%) | 0.041 | |
R1 | 21 (43.8%) | 31 (64.6%) | |||
Overall | R0 | 71 (71%) | 56 (56%) | 0.034 | |
R1 | 29 (29%) | 43 (43%) | |||
Missing | 0 (0%) | 1 (1%) | |||
Patients with undetectable PSA at 3 months postoperatively (ng/mL) | 85 (85%) | 85 (85%) | 1.000 | ||
Biochemical recurrence | 0.540 | ||||
No | 73 (73%) | 76 (76%) | |||
Yes | 27 (27%) | 23 (23%) | |||
Missing | 0 (0%) | 1 (1%) | |||
Postoperative radiotherapy | 0.605 | ||||
No | 77 (77%) | 78 (78%) | |||
Adjuvant | 1 (1%) | 0 (0%) | |||
Salvage | 21 (21%) | 21 (21%) | |||
Missing | 1 (1%) | 1 (1%) | |||
Development of metastatic PCa | 2 (2%) | 0 (0%) | 0.157 | ||
Follow-up (months) | 24.5 (17–35) | 22 (18–27) | 0.008 |
Variable | Odds Ratio | 95% CI | p | |
---|---|---|---|---|
Univariate Logistic Regression | ||||
iPSA | 1.14 | 1.03–1.26 | 0.011 | |
pT | ||||
pT2 | Ref | |||
pT3 | 19.06 | 4.15–87.53 | <0.001 | |
Lymphovascular invasion | ||||
No | Ref | |||
Yes | 11.25 | 1.11–114.05 | 0.041 | |
Surgical margin status | ||||
R0 | Ref | |||
R1 | 3.21 | 1.21–8.53 | 0.019 | |
ISUP Grade Group | ||||
1 | Ref | |||
2–3 | 3.39 × 108 | / | 1.00 | |
4–5 | 1.79 × 109 | / | 1.00 | |
Multivariate Logistic Regression | ||||
iPSA | 1.13 | 1.00–1.28 | 0.054 | |
pT | ||||
pT2 | Ref | |||
pT3 | 14.99 | 2.77–81.11 | 0.002 | |
Lymphovascular invasion | ||||
No | Ref | |||
Yes | 13.52 | 0.85–216.28 | 0.066 | |
Surgical margin status | ||||
R0 | Ref | |||
R1 | 2.05 | 0.56–7.54 | 0.281 |
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Lambert, E.; Allaeys, C.; Berquin, C.; De Visschere, P.; Verbeke, S.; Vanneste, B.; Fonteyne, V.; Van Praet, C.; Lumen, N. Is It Safe to Switch from a Standard Anterior to Retzius-Sparing Approach in Robot-Assisted Radical Prostatectomy? Curr. Oncol. 2023, 30, 3447-3460. https://doi.org/10.3390/curroncol30030261
Lambert E, Allaeys C, Berquin C, De Visschere P, Verbeke S, Vanneste B, Fonteyne V, Van Praet C, Lumen N. Is It Safe to Switch from a Standard Anterior to Retzius-Sparing Approach in Robot-Assisted Radical Prostatectomy? Current Oncology. 2023; 30(3):3447-3460. https://doi.org/10.3390/curroncol30030261
Chicago/Turabian StyleLambert, Edward, Charlotte Allaeys, Camille Berquin, Pieter De Visschere, Sofie Verbeke, Ben Vanneste, Valerie Fonteyne, Charles Van Praet, and Nicolaas Lumen. 2023. "Is It Safe to Switch from a Standard Anterior to Retzius-Sparing Approach in Robot-Assisted Radical Prostatectomy?" Current Oncology 30, no. 3: 3447-3460. https://doi.org/10.3390/curroncol30030261
APA StyleLambert, E., Allaeys, C., Berquin, C., De Visschere, P., Verbeke, S., Vanneste, B., Fonteyne, V., Van Praet, C., & Lumen, N. (2023). Is It Safe to Switch from a Standard Anterior to Retzius-Sparing Approach in Robot-Assisted Radical Prostatectomy? Current Oncology, 30(3), 3447-3460. https://doi.org/10.3390/curroncol30030261