Study Evaluates Outcomes of Robot-Assisted Radical Prostatectomy Approaches for Patients With Prostate Cancer

Robot-assisted radical prostatectomy (RARP) is well-known as the gold standard and the “most utilized surgical modality” to treat patients with prostate cancer. As other modalities have become widely accepted, such as the retzius-sparing technique, researchers are evaluating “new robotic platforms aimed at improving patient/surgeon experience as well as functional outcomes.”

A recent study assessed pathologic and short-term oncological and survival outcomes of prostate cancer surgical approaches, with a specific focus on transvesical single-port RARP versus multi-port transperitoneal RARP.

Tarik Benidir, MD, of the Cleveland Clinic, and colleagues conducted a retrospective review on “prospectively collected data” from 169 patients. According to the study, the patients had either low or intermediate-risk prostate cancer and received either a single-port transvesical or a multi-port transperitoneal RARP “by a single surgeon between 2015 and 2022.”

The review assessed and compared preoperative clinicopathologic characteristics and final histopathology outcomes. Evaluation of the effect of the surgical modality on biochemical recurrence (BCR)-free survival within 12 months was conducted using the univariate cox proportional hazard analysis.

Eighty-five patients underwent single-port transvesical RARP and 84 patients underwent multi-port transperitoneal RARP. Final Gleason Grades, T stage, adverse pathological features, and positive surgical margins were assessed as histopathologic outcomes. The researchers found that both groups had similar preoperative clinicopathologic features, as well as “identical” histopathology outcomes.

The study reported “no statistically significant difference in the rates of lymph node invasion (P=.08),” although the lower median number of nodes in the single-port group was lower than that of the multi-port group, measuring two and six nodes, respectively.

No differences in BCR-free survival rates were observed among either group at the median follow up point of 12 months (P=.38). According to the univariate cox proportional hazard analysis used by the researchers, surgical modality was not considered as an “independent predictor of biochemical recurrence (HR 0.53, 95% CI, 0.13-2.23, P=.39).”

The researchers concluded that in “well-selected patients,” single port transvesical versus multi-port transperitoneal RARP showed similar short-term oncologic outcomes, surgical margin status, and one-year BCR rate. However, the single-port approach provided “superior functional outcomes” for patients. For that reason, the investigators stated that the “innovative retzius-sparing approach” was a “suitable strategy in well-selected patients and may serve as the ideal retzius-sparing approach in anteriorly located lesions.”

Source: Urologic Oncology: Seminars and Original Investigations