TY - JOUR
T1 - Retzius-sparing robotic-assisted laparoscopic radical prostatectomy
T2 - racial considerations for 250 consecutive cases
AU - Sayyid, Rashid K.
AU - Sherwood, Dalton
AU - Simpson, William G.
AU - Terris, Martha K.
AU - Klaassen, Zachary
AU - Madi, Rabii
N1 - Publisher Copyright:
© 2020, Springer-Verlag London Ltd., part of Springer Nature.
PY - 2021/4
Y1 - 2021/4
N2 - 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.
AB - 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.
KW - Outcome assessment (health care)
KW - Prostatectomy
KW - Prostatic neoplasms
KW - Robotic surgical procedures
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U2 - 10.1007/s11701-020-01096-1
DO - 10.1007/s11701-020-01096-1
M3 - Article
C2 - 32472391
AN - SCOPUS:85085594475
SN - 1863-2483
VL - 15
SP - 221
EP - 228
JO - Journal of Robotic Surgery
JF - Journal of Robotic Surgery
IS - 2
ER -