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Retzius-sparing Robot-assisted Radical Prostatectomy Leads to Durable Improvement in Urinary Function and Quality of Life Versus Standard Robot-assisted Radical Prostatectomy Without Compromise on Oncologic Efficacy: Single-surgeon Series and Step-by-step Guide.
Eur Urol. 2020 Jun 11 [Online ahead of print]EU

Abstract

BACKGROUND

Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) has been shown to improve continence. However, questions remain regarding feasibility and generalizability of technique and outcomes.

OBJECTIVE

To compare the outcomes of 140 consecutive standard robot-assisted radical prostatectomy (S-RARP) versus RS-RARP.

DESIGN, SETTING, AND PARTICIPANTS

A total of 70 S-RARPs were performed followed by 70 RS-RARPs. Demographic, pathologic, and functional outcomes were compared preoperatively and through 12 mo. Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) was used to compare functional outcomes. Logistic and linear regression analyses were utilized to analyze variables associated with EPIC-CP urinary incontinence and overall quality of life (QOL) scores, and oncologic outcomes. Cox regression analysis was used to analyze incontinence at 12 mo.

SURGICAL PROCEDURE

RS-RARP versus S-RARP.

MEASUREMENTS

Patient and tumor characteristics (age, body mass index, prostate-specific antigen, Charlson Comorbidity Index, Gleason group, clinical stage, and Prostate Imaging Reporting and Data System score), perioperative outcomes (console time, estimated blood loss, postoperative complications, and length of stay), oncologic outcomes (positive surgical margin [PSM], and biochemical recurrence), overall and 12-mo continence rates (zero pads and zero to one safety pad), time to continence, potency (erection sufficient for sexual activity), EPIC-CP urinary incontinence, sexual function, and overall QOL scores.

RESULTS AND LIMITATIONS

Median follow-up for S-RARP versus RS-RARP was 46.3 versus 12.3 mo. RS-RARP versus S-RARP had improved overall continence rates at total follow-up (95.7% vs 85.7%, p = 0.042) and 12-mo follow-up (97.6% vs 81.4%, p = 0.002), and faster return to continence (zero to one safety pad, 44 vs 131 d, p < 0.001). RS-RARP EPIC-CP urinary incontinence and overall QOL scores remained significantly better at 12 mo. There were no differences in overall PSM rates, although RS-RARP had lower rates of nonfocal PSMs. There were no differences in sexual function. In multivariate analysis, RS-RARP was significantly associated with improved 12-mo EPIC-CP urinary incontinence and improved QOL scores, but was not associated with PSM or biochemical recurrence. Limitations include retrospective study design and unequal follow-up; however, significantly better RS-RARP continence at 12 mo is striking despite fewer patients attaining 12-mo follow-up.

CONCLUSIONS

RS-RARP significantly improves early and long-term continence without compromising oncologic outcomes and leads to overall improved QOL.

PATIENT SUMMARY

Retzius-sparing robot-assisted radical prostatectomy is an emerging technique for robotic radical prostatectomy that improves urinary function and quality of life without compromising cancer control.

Authors+Show Affiliations

Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA.Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA.Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA.Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA.Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA.Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA.Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA.Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA.Department of Urology, Weill Cornell Medicine, New York, NY, USA.Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA. Electronic address: keith.kowalczyk@medstar.net.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32536488

Citation

Egan, Jillian, et al. "Retzius-sparing Robot-assisted Radical Prostatectomy Leads to Durable Improvement in Urinary Function and Quality of Life Versus Standard Robot-assisted Radical Prostatectomy Without Compromise On Oncologic Efficacy: Single-surgeon Series and Step-by-step Guide." European Urology, 2020.
Egan J, Marhamati S, Carvalho FLF, et al. Retzius-sparing Robot-assisted Radical Prostatectomy Leads to Durable Improvement in Urinary Function and Quality of Life Versus Standard Robot-assisted Radical Prostatectomy Without Compromise on Oncologic Efficacy: Single-surgeon Series and Step-by-step Guide. Eur Urol. 2020.
Egan, J., Marhamati, S., Carvalho, F. L. F., Davis, M., O'Neill, J., Lee, H., Lynch, J. H., Hankins, R. A., Hu, J. C., & Kowalczyk, K. J. (2020). Retzius-sparing Robot-assisted Radical Prostatectomy Leads to Durable Improvement in Urinary Function and Quality of Life Versus Standard Robot-assisted Radical Prostatectomy Without Compromise on Oncologic Efficacy: Single-surgeon Series and Step-by-step Guide. European Urology. https://doi.org/10.1016/j.eururo.2020.05.010
Egan J, et al. Retzius-sparing Robot-assisted Radical Prostatectomy Leads to Durable Improvement in Urinary Function and Quality of Life Versus Standard Robot-assisted Radical Prostatectomy Without Compromise On Oncologic Efficacy: Single-surgeon Series and Step-by-step Guide. Eur Urol. 2020 Jun 11; PubMed PMID: 32536488.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Retzius-sparing Robot-assisted Radical Prostatectomy Leads to Durable Improvement in Urinary Function and Quality of Life Versus Standard Robot-assisted Radical Prostatectomy Without Compromise on Oncologic Efficacy: Single-surgeon Series and Step-by-step Guide. AU - Egan,Jillian, AU - Marhamati,Shawn, AU - Carvalho,Filipe L F, AU - Davis,Meghan, AU - O'Neill,John, AU - Lee,Harry, AU - Lynch,John H, AU - Hankins,Ryan A, AU - Hu,Jim C, AU - Kowalczyk,Keith J, Y1 - 2020/06/11/ PY - 2020/03/15/received PY - 2020/05/12/accepted PY - 2020/6/16/entrez KW - Incontinence KW - Outcomes KW - Prostate cancer KW - Retzius sparing prostatectomy KW - Robotic-assisted surgery KW - Urinary function JF - European urology JO - Eur. Urol. N2 - BACKGROUND: Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) has been shown to improve continence. However, questions remain regarding feasibility and generalizability of technique and outcomes. OBJECTIVE: To compare the outcomes of 140 consecutive standard robot-assisted radical prostatectomy (S-RARP) versus RS-RARP. DESIGN, SETTING, AND PARTICIPANTS: A total of 70 S-RARPs were performed followed by 70 RS-RARPs. Demographic, pathologic, and functional outcomes were compared preoperatively and through 12 mo. Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) was used to compare functional outcomes. Logistic and linear regression analyses were utilized to analyze variables associated with EPIC-CP urinary incontinence and overall quality of life (QOL) scores, and oncologic outcomes. Cox regression analysis was used to analyze incontinence at 12 mo. SURGICAL PROCEDURE: RS-RARP versus S-RARP. MEASUREMENTS: Patient and tumor characteristics (age, body mass index, prostate-specific antigen, Charlson Comorbidity Index, Gleason group, clinical stage, and Prostate Imaging Reporting and Data System score), perioperative outcomes (console time, estimated blood loss, postoperative complications, and length of stay), oncologic outcomes (positive surgical margin [PSM], and biochemical recurrence), overall and 12-mo continence rates (zero pads and zero to one safety pad), time to continence, potency (erection sufficient for sexual activity), EPIC-CP urinary incontinence, sexual function, and overall QOL scores. RESULTS AND LIMITATIONS: Median follow-up for S-RARP versus RS-RARP was 46.3 versus 12.3 mo. RS-RARP versus S-RARP had improved overall continence rates at total follow-up (95.7% vs 85.7%, p = 0.042) and 12-mo follow-up (97.6% vs 81.4%, p = 0.002), and faster return to continence (zero to one safety pad, 44 vs 131 d, p < 0.001). RS-RARP EPIC-CP urinary incontinence and overall QOL scores remained significantly better at 12 mo. There were no differences in overall PSM rates, although RS-RARP had lower rates of nonfocal PSMs. There were no differences in sexual function. In multivariate analysis, RS-RARP was significantly associated with improved 12-mo EPIC-CP urinary incontinence and improved QOL scores, but was not associated with PSM or biochemical recurrence. Limitations include retrospective study design and unequal follow-up; however, significantly better RS-RARP continence at 12 mo is striking despite fewer patients attaining 12-mo follow-up. CONCLUSIONS: RS-RARP significantly improves early and long-term continence without compromising oncologic outcomes and leads to overall improved QOL. PATIENT SUMMARY: Retzius-sparing robot-assisted radical prostatectomy is an emerging technique for robotic radical prostatectomy that improves urinary function and quality of life without compromising cancer control. SN - 1873-7560 UR - https://www.unboundmedicine.com/medline/citation/32536488/Retzius_sparing_Robot_assisted_Radical_Prostatectomy_Leads_to_Durable_Improvement_in_Urinary_Function_and_Quality_of_Life_Versus_Standard_Robot_assisted_Radical_Prostatectomy_Without_Compromise_on_Oncologic_Efficacy:_Single_surgeon_Series_and_Step_by_step_Guide_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302-2838(20)30350-X DB - PRIME DP - Unbound Medicine ER -
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