MP45-18 IS RETZIUS-SPARING ROBOT-ASSISTED RADICAL PROSTATECTOMY THE MORE ANATOMICAL APPROACH? – COMPARISON WITH CONVENTIONAL ROBOTIC PROSTATECTOMY (2014)

You have accessJournal of UrologyProstate Cancer: Localized III1 Apr 2014MP45-18 IS RETZIUS-SPARING ROBOT-ASSISTED RADICAL PROSTATECTOMY THE MORE ANATOMICAL APPROACH? – COMPARISON WITH CONVENTIONAL ROBOTIC PROSTATECTOMY Patrick Tuliao, Christos Komninos, Kyo Chul Koo, Chien Hsiang Cheng, Young Deuk Choi, Byung Ha Chung, Sung Joon Hong, and Koon Ho Rha Patrick TuliaoPatrick Tuliao More articles by this author , Christos KomninosChristos Komninos More articles by this author , Kyo Chul KooKyo Chul Koo More articles by this author , Chien Hsiang ChengChien Hsiang Cheng More articles by this author , Young Deuk ChoiYoung Deuk Choi More articles by this author , Byung Ha ChungByung Ha Chung More articles by this author , Sung Joon HongSung Joon Hong More articles by this author , and Koon Ho RhaKoon Ho Rha More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1215AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Being a relatively new approach, the disadvantages and advantages of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) over the conventional (C-RARP) approach are yet to be determined. This study aims to compare the oncological, safety and functional outcomes between RS-RARP and C-RARP. Methods Data was collected from a data base of 1,295 cases of robot-assisted radical prostatectomy performed by a single surgeon from 2005 to 2013. To eliminate the learning curve factor and decrease selection bias, 120 RS-RARP cases were matched to the most recently performed 250 cases of C-RARP cases by propensity scoring using age, body mass index (BMI), clinical T stage, biopsy Gleason score, number of biopsy cores and ultrasound prostate volume. Surgical margins, peri-operative complications and urinary continence were used to compare oncological, safety and functional outcomes. Results Evaluation of 120 RS-RARP and 120 C-RARP cases was done after propensity matching. Patient age, BMI, clinical T stage, biopsy Gleason score, number of biopsy cores and prostate volume were similar between the two groups (p>0.050). The mean console time of RS-RARP is shorter than that of C-RARP cases (114.06 vs. 187.61, p=<0.001). There are more pathological T3 and T4 tumors in the RS-RARP group than in the C-RARP group, but positive margin rates were comparable even when comparing similar pathological T stages (Table 1). However, there were significantly more positive anterior margins in RS-RARP cases than in C-RARP cases (21.9% vs. 9.6%, p<0.001). The frequencies of post-operative complications are similar between techniques (5.8% vs. 5.0%, p=0.576). Comparing only cases wherein node dissection was performed, early continence is better after RS-RARP than after C-RARP (85.2% vs. 53.4%, p<0.001). After RS-RARP, early continence is better for men younger than 65 years than those who are older (85.7% vs. 79.9%, p=0.048). Conclusions Compared to C-RARP, RS-RARP has a shorter console time, comparable overall positive margin rates, is safe, and provides superior early continence rates. Table 1. Comparison of pertinent characteristics between RS-RARP and C-RARP after propensity score matching RS-RARP, N=120 C-RARP, N=120 p Value Mean Age, years (SD) 65.53 (7.661) 66.10 (6.32) 0.752 Mean body mass index (SD) 24.15 (2.74) 24.5 (3.00) 0.628 Transrectal ultrasound prostate volume, g (SD) 33.29 (15.75) 33.24 (13.34) 0.591 Pre-operative PSA, ng/dl (SD) 13.21 (13.06) 11.08 (12.95) 0.210 Mean Number of biopsy cores(SD) 12.79 (2.72) 11.57 (2.31) 1.000 Mean console time, min (SD) 114.06 (29.30) 187.61 (38.83) < 0.001∗ Mean estimated blood loss, ml (SD) 313.59 (206.63) 286.06 (208.80) 0.174 Pathologic GS (%) 0.420 6 35 (29.3) 20 (19.4) 7 61 (51.3) 53 (51.5) 8-10 23 (19.3) 30 (29.1) Pathologic T stage (%) 0.006∗ T1-T2a 20 (16.8) 18 (13.5) T2b-T2c 35 (45.8) 63 (52.5) T3-T4 44 (36.9) 28 (23.3) Overall positive surgical margins (%) For all pT stages 44 (45.8) 57 (44.9) 0.304 For pT2 stages 31 (41.3) 25 (39.7) 0.564 For pT3 stages 23 (51.2) 14 (53.8) 0.401 Positive anterior margins (%) For all pT stages 21 (21.9) 10 (9.6) < 0.001∗ For pT2 stages 14 (18.2) 7 (11.1) 0.029∗ For pT3 stages 15 (34.9) 1 (3.8) 0.003∗ Intra-operative injury and post-operative complications excluding lymphocoeles (%) 7 (5.8) 6 (5.0) 0.576 Urinary continence for cases wherein PLND was done (%) After 1 month 77 (82.8) 47 (53.4) < 0.001∗ After 2 months 92 (90.1) 52 (65.0) < 0.001∗ After 3 months 65 (100) 46 (75.4) < 0.001∗ After 4 months 43 (100) 40 (80.0) < 0.001∗ After 5 months 18 (100) 31 (79.5) < 0.001∗ After 6 months 18 (100) 10 (62.5) < 0.001∗ ∗ Significant; GS=Gleason score © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e466-e467 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Patrick Tuliao More articles by this author Christos Komninos More articles by this author Kyo Chul Koo More articles by this author Chien Hsiang Cheng More articles by this author Young Deuk Choi More articles by this author Byung Ha Chung More articles by this author Sung Joon Hong More articles by this author Koon Ho Rha More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...