Outcomes of robot-assisted laparoscopic radical prostatectomy in high-risk prostate cancer patients: experience in 34 patients with oncologic and functional outcomes

Abstract

Introduction:

In this retrospective study, we report outcomes of robot-assisted laparoscopic radical prostatectomy (RARP) in high-risk prostate cancer (HRPC) classified according to a D’Amico risk group with minimum 1-year follow-up.

Methods:

A total of 34 patients who had at least one preoperative HRPC feature and who underwent RARP were included. Mean patient age and preoperative serum prostate-specific antigen levels were 62.6±6.4 years and 12.2±9.1 ng/mL, respectively. Preoperatively, two (5.8%), one (2.9%), eleven (32.3%), three (8.8%), and 17 (50%) patients had prostate biopsy Gleason scores of 5+4, 4+5, 4+4, 3+5, and <8, respectively. Bilateral neurovascular bundle (NVB)-sparing, unilateral NVB-sparing, and non-NVB-sparing surgery was performed in 16 (47%), five (15%), and 13 (38%) patients, respectively.

Results:

Mean console time, intraoperative blood loss, duration of hospital stay, and urethral catheter removal time were 162.1±64.4 minutes, 232.2±255.1 cc, 4.1±2.1 days, and 12.6±6.2 days, respectively. During the perioperative period (0–30 days), three minor and five major complications occurred as classified using the modified Clavien classification. No complication was detected during postoperative 31–90 days. Postoperative pathologic stages included pT0, pT2a, pT2b, pT2c, pT3a, and pT3b disease in two (5.8%), five (14.7%), three (8.8%), six (17.6%), ten (29.4%), and eight (23.5%) patients, respectively. Positive surgical margin rate was 32.3%. Mean lymph node yield was 11.8±8.3 (range three to 37). Mean follow-up was 27.8±11.1 months. Biochemical recurrence was detected in nine (26.4%) patients. Of the patients, 17 (50%) were fully continent (zero pads/day), six (17.7%) wore a safety pad/day, six (17.7%) wore one pad/day, three (8.8%) wore two pads/day, and two (5.9%) wore more than two pads/day. Of the 24 patients with no preoperative erectile dysfunction, 15 (44.1%) had no erectile dysfunction at a mean follow-up of 1 year. Trifecta and pentafecta rates were 38% and 26%, respectively.

Conclusion:

Based on our experience, RARP in HRPC is a safe procedure with satisfactory oncologic and functional outcomes.

Keywords::

• robotic radical prostatectomy
• high-risk prostate cancer
• outcomes
• minimally invasive surgery
• robotic surgery