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Retzius-sparing robotic-assisted laparoscopic radical prostatectomy: racial considerations for 250 consecutive cases

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Abstract

Our objective is to report the functional and oncologic outcomes of a cohort of 250 consecutive prostate cancer patients undergoing a Retzius-sparing approach and to assess for racial differences in continence outcomes. This was a prospective, single-center, case series of 250 consecutive prostate cancer patients who underwent a Retzius-sparing robotic-assisted laparoscopic radical prostatectomy by a single surgeon between May 2015 and April 2019. Our primary objective was to report post-operative continence outcomes of patients undergoing this technique. Continence was defined as using zero or one precautionary pad per day. Median follow-up was 24.0 months [interquartile range (IQR) 18.0–30.0 months]. Median age and body mass index were 62.0 years (IQR 57.0–67.0) and 29.0 kg/m2 (IQR 26.0–33.0), respectively. Median PSA was 8.22 ng/ml (IQR 5.74–13.31). 84.8% of patients were intermediate risk or high risk pre-operatively, as per AUA/ASTRO/SUO guidelines. 96.0% had Gleason Score 7 or worse disease on final pathologic analysis. Positive margin incidence was 18.1% and 44.4% in patients with pT2 and pT3 disease, respectively, of which 75.4% were unifocal. Immediate continence (i.e., continence achieved within 1 month post-operatively) was achieved in 45.2% of patients. Three-month and 1-year continence rates were 70.0% and 92.0%, respectively. Caucasian patients experienced earlier return of continence (77% versus 65% at 3 months) compared to African American patients. IPSS scores gradually improved from 8.0 pre-operatively to 4.0 1-year later. Median PSA level was 0.01 ng/ml (IQR 0.01–9.01) post-operatively. Retzius-sparing robotic-assisted laparoscopic radical prostatectomy is an oncologically safe surgical technique with excellent short- and long-term continence outcomes. Caucasian patients may have earlier return of continence compared to African Americans.

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References

  1. Haglind E, Carlsson S, Stranne J et al (2015) Urinary incontinence and erectile dysfunction after robotic versus open radical prostatectomy: a prospective, controlled. Nonrandm Trial Eur Urol 68(2):216–225

    Article  Google Scholar 

  2. Shikanov SA, Zorn KC, Zagaja GP, Shalhav AL (2009) Trifecta outcomes after robotic-assisted laparoscopic prostatectomy. Urology 74(3):619–623

    Article  Google Scholar 

  3. Novara G, Ficarra C, D’Elia C, Secco S, Cavalleri S, Artibani W (2011) Trifecta outcomes after robot-assisted laparoscopic radical prostatectomy. BJU Int 107(1):100–104

    Article  Google Scholar 

  4. Ou YC, Yang CK, Kang HM et al (2015) Pentafecta outcomes of 230 cases of robotic-assisted radical prostatectomy with bilateral neurovascular bundle preservation. Anticancer Res 35(9):5007–5013

    PubMed  Google Scholar 

  5. Walz J, Burnett AL, Costello AJ et al (2010) A critical analysis of the current knowledge of surgical anatomy related to optimization of cancer control and preservation of continence and erection in candidates for radical prostatectomy. Eur Urol 57:179–192

    Article  Google Scholar 

  6. Galfano A, Ascione A, Grimaldi S et al (2010) A new anatomic approach for robota ssisted laparoscopic prostatectomy: a feasibility study for completely intrafascial surgery. Eur Urol 58:457–461

    Article  Google Scholar 

  7. Lim SK, Kim KH, Shin TY et al (2014) Retzius-sparing robot-assisted laparoscopic radical prostatectomy: combining the best of retropubic and perineal approaches. BJU Int 114(2):236–244

    Article  Google Scholar 

  8. Dalela D, Jeong W, Prasad M et al (2017) A pragmatic randomized controlled trial examining the impact of the retzius-sparing approach on early urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol 72(5):677–685

    Article  Google Scholar 

  9. Chang L, Hung S, Hu J, Chiu K (2018) Retzius-sparing robotic-assisted radical prostatectomy associated with less bladder neck descent and better early continence outcome. Anticancer Res 38(1):345–351

    PubMed  Google Scholar 

  10. Nyarangi-Dix JN, Gortz M, Gradinarov G et al (2019) Retzius-sparing robot-assisted laparoscopic radical prostatectomy: functional and early oncologic results in aggressive and locally advanced prostate cancer. BMC Urol 19(1):113

    Article  Google Scholar 

  11. Sayyid RK, Simpson WG, Lu C et al (2017) Retzius-sparing robotic-assisted laparoscopic radical prostatectomy: a safe surgical technique with superior continence outcomes. J Endourol 31(12):1244–1250

    Article  Google Scholar 

  12. Milonas D, Venclovas Z, Muilwijk T, Jievaltas M, Joniau S (2020) External validation of Memorial Sloan Kettering Cancer Center nomogram and prediction of optimal candidate for lymph node dissection in clinically localized prostate cancer. Cent Eur J Urol 73(1):19–25

    Google Scholar 

  13. Galfano A, Trapani DD, Sozzi F et al (2013) Beyond the learning curve of the retzius-sparing approach for robot-assisted laparoscopic radical prostatectomy: oncologic and functional results of the first 200 patients with ≥1 year of follow-up. Eur Urol 64:974–980

    Article  Google Scholar 

  14. Vickers A, Bianco F, Cronin A et al (2010) The learning curve for surgical margins after open radical prostatectomy: implications for margin status as an oncological end point. J Urol 183(4):1360–1365

    Article  Google Scholar 

  15. Sanda MG, Cadeddu JA, Kirkby E et al (2018) Clinically localized prostate cancer: AUA/ASTRO/SUO guideline. J Urol 199(3):683–690

    Article  Google Scholar 

  16. Epstein JI, Egevad L, Amin MB et al (2016) The 2014 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma: definition of grading patterns and proposal for a new grading system. Am J Surg Pathol 40(2):244–252

    Article  Google Scholar 

  17. Sayyid RK, Madi R (2018) The untold advantages of retzius-sparing robotic radical prostatectomy. J Endourol 32(7):671–672

    Article  Google Scholar 

  18. Chang KD, Abdel Raheem A, Santok GDR et al (2017) Anatomical Retzius-space preservation is associated with lower incidence of postoperative inguinal hernia development after robot-assisted radical prostatectomy. Hernia 21(4):555–561

    Article  CAS  Google Scholar 

  19. Turner W (1885) The index of the pelvic brim as a basis of classification. J Anat Physiol 20(1):125–143

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Rabbani F, Yunis LH, Vora K et al (2009) Impact of ethnicity on surgical margins at radical prostatectomy. BJU Int 104(7):904–908

    Article  Google Scholar 

  21. SEARCH Database Study Group, Jayachandran J, Aronson WJ et al (2008) Obesity and positive surgical margins by anatomic location after radical prostatectomy: results from the Shared Equal Access Regional Cancer Hospital database. BJU Int 102(8):964–968

    Article  Google Scholar 

  22. Menon M, Dalela D, Jamil M et al (2018) Functional recovery, oncologic outcomes and postoperative complications after robot-assisted radical prostatectomy: an evidence-based analysis comparing the Retzius sparing and standard approaches. J Urol 199(5):1210–1217

    Article  Google Scholar 

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Acknowledgements

Meghan Neace, B.S., B.F.A., M.S.M.I. for her contributions to the illustrations (Figs. 1, 4).

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Authors and Affiliations

  1. Division of Urology, Department of Surgery, Section of Urology, Augusta University, 1120 15th Street, BA-8414, Augusta, GA, 30912-4050, USA

    Rashid K. Sayyid, William G. Simpson, Martha K. Terris, Zachary Klaassen & Rabii Madi

  2. Medical College of Georgia, Augusta, USA

    Dalton Sherwood

  3. Georgia Cancer Center, Augusta, USA

    Martha K. Terris, Zachary Klaassen & Rabii Madi

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  1. Rashid K. Sayyid
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  2. Dalton Sherwood
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  3. William G. Simpson
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  4. Martha K. Terris
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  5. Zachary Klaassen
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  6. Rabii Madi
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Contributions

RKS: conception and design; data acquisition; data analysis and interpretation; drafting manuscript; statistical analysis. DS: data acquisition; critical revision of manuscript for scientific and factual content. WGS: data acquisition; critical revision of manuscript for scientific and factual content. MKT: data analysis and interpretation; critical revision of manuscript for scientific and factual content; supervision. ZK: conception and design; data analysis and interpretation; drafting manuscript; supervision. RM: conception and design; data acquisition; data analysis and interpretation; drafting manuscript; supervision.

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Correspondence to Rabii Madi.

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Rashid K. Sayyid, Dalton Sherwood, William G. Simpson, Martha K. Terris, Zachary Klaassen, and Rabii Madi declare no relevant conflicts of interest.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Augusta University.

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Sayyid, R.K., Sherwood, D., Simpson, W.G. et al. Retzius-sparing robotic-assisted laparoscopic radical prostatectomy: racial considerations for 250 consecutive cases. J Robotic Surg 15, 221–228 (2021). https://doi.org/10.1007/s11701-020-01096-1

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  • DOI: https://doi.org/10.1007/s11701-020-01096-1

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