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Laparoscopic versus robot-assisted bilateral nerve-sparing radical prostatectomy: comparison of pentafecta rates for a single surgeon

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An Erratum to this article was published on 31 August 2013

Abstract

Background

This study aimed to compare the pentafecta rates between laparoscopic radical prostatectomy (LRP) and robot-assisted radical prostatectomy (RALP) and to identify prognostic factors predicting the pentafecta for each technique.

Methods

This prospective comparative study enrolled 248 consecutive male patients 70 years of age or younger with clinically localized prostate cancer [PCa: age ≤70 years, prostate-specific antigen (PSA) ≤10 ng/ml, biopsy Gleason score ≤7] who were fully continent, potent, and candidates for bilateral nerve-sparing (BNS) LRP or RALP. The pentafecta rates between LRP and RALP were compared. A logistic regression model was created to evaluate independent factors for achieving pentafecta.

Results

In the final analysis, 91 LRP and 136 RALP patients were evaluated. The median follow-up period was 21 months for the 91 LRP patients and 18 months for the 136 RALP patients (p = 0.07). Of the 227 patients, 87 reached pentafecta [25 LRP patients (27.5 %) vs 62 RALP patients (45.6 %), p = 0.006]. Of the 140 patients who failed pentafecta, 90 (64.3 %) missed a single parameter, and the difference between the groups was significant (80 % LRP vs 53.3 % RALP, p = 0.007). Lower age, lower pathologic stage, and RALP are significantly associated with pentafecta as independent factors. For the pT3 disease, the two techniques did not differ significantly.

Conclusions

Patients submitted to BNS RP have low possibilities of achieving pentafecta. Use of the robotic platform by a single surgeon significantly enhances the possibility of achieving pentafecta independently of age and pathologic stage. Potency was the most difficult outcome to reach after surgery, and it was the main factor leading to pentafecta failure. LRP and RALP provide equivalent pentafecta rates for the pT3 disease and similar “tetrafecta” outcomes when potency recovery is not included among the postoperative expectations of the patient.

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Disclosures

Drs. Anastasios D. Asimakopoulos, Roberto Miano, Nicola Di Lorenzo, Enrico Spera, Giuseppe Vespasiani, and Camille Mugnier have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. UOC of Urology, Department of Surgery, University of Tor Vergata, Policlinico Casilino, Rome, Italy

    Anastasios D. Asimakopoulos & Enrico Spera

  2. Division of Urology, Clinique Saint-Augustin, Bordeaux, France

    Anastasios D. Asimakopoulos & Camille Mugnier

  3. UOC of Urology, Department of Surgery, University of Tor Vergata, Policlinico Tor Vergata, Rome, Italy

    Roberto Miano & Giuseppe Vespasiani

  4. Department of Surgical Sciences, University of Tor Vergata, Policlinico Tor Vergata, Rome, Italy

    Nicola Di Lorenzo

Authors
  1. Anastasios D. Asimakopoulos
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  2. Roberto Miano
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  3. Nicola Di Lorenzo
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  6. Camille Mugnier
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Correspondence to Anastasios D. Asimakopoulos.

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Asimakopoulos, A.D., Miano, R., Di Lorenzo, N. et al. Laparoscopic versus robot-assisted bilateral nerve-sparing radical prostatectomy: comparison of pentafecta rates for a single surgeon. Surg Endosc 27, 4297–4304 (2013). https://doi.org/10.1007/s00464-013-3046-9

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  • DOI: https://doi.org/10.1007/s00464-013-3046-9

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