Retzius-sparing robotic radical prostatectomy for high-risk prostate cancer
BAUS ePoster online library. Eden C.
Jun 26, 2018; 211349
Christopher Eden
Christopher Eden
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Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) produced significantly better early urinary continence than its non-RS counterpart in a randomised controlled trial. Concerns exist however that it might not allow due to its technical difficulty and the paucity of landmarks a sufficiently wide excision of the prostate when needed and might therefore be unsuitable for higher risk prostate cancers.

Of 160 consecutive patients having RS-RARP done by the same surgeon during a 16-month period, 55 had d'Amico high-risk prostate cancer. All patients had an extended pelvic lymphadenectomy. Their results were compared with a matched (for high-risk parameters) group of 55 high-risk patients operated on robotically by the same surgeon immediately prior to the adoption of RS-RARP. The mean follow-up in RS- and non-RS-RARP patients was 8 (1-16) months & 24 (16-33) months.

Patients in the 2 groups had similar age, BMI, PSA, biopsy Gleason sum, clinical stage, operating time, extent of nerve-sparing surgery, blood loss, complication rate, prostate weight, LN yield and post-op. hospital stay.

RS-RARP produces dramatically better (10x) urinary continence at 4 weeks (p=<0.0001) than non-RS-RARP and does not appear to negatively impact short-terms indicators of cancer control in patients with high-risk prostate cancer. Earlier recovery of continence post surgery allows this group of patients to undergo adjuvant radiotherapy as part of multimodality treatment quicker representing an underestimated benefit of the approach. Clearly, longer follow-up is needed to determine its impact on cancer control.
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