Retzius-sparing robotic prostatectomy is associated with higher positive surgical margin rate in anterior tumors, but not in posterior tumors, compared to conventional anterior robotic prostatectomy

Masashi Oshima; Satoshi Washino; Yuhki Nakamura; Tsuzumi Konishi; Kimitoshi Saito; Tomoaki Miyagawa

doi:10.1016/j.prnil.2022.07.005

Retzius-sparing robotic prostatectomy is associated with higher positive surgical margin rate in anterior tumors, but not in posterior tumors, compared to conventional anterior robotic prostatectomy

Prostate Int. 2023 Mar;11(1):13-19. doi: 10.1016/j.prnil.2022.07.005. Epub 2022 Aug 9.

Authors

Masashi Oshima¹, Satoshi Washino¹, Yuhki Nakamura¹, Tsuzumi Konishi¹, Kimitoshi Saito¹, Tomoaki Miyagawa¹

Affiliation

¹ Department of Urology, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Saitama-shi, Saitama, 330-8503, Japan.

Abstract

Objectives: The analysis of the oncological outcomes and postoperative continence recovery between conventional robotic-assisted radical prostatectomy (cRARP) and Retzius-sparing RARP (rsRARP), and the effect of the tumor location on them.

Materials and methods: A total of 317 patients who underwent cRARP (n = 228) or rsRARP (n = 89) from August 2017 to July 2020 were assessed. Patients were categorized into groups based on the tumor location by pathology. Positive surgical margin (PSM) rates and biochemical recurrence (BCR)-free survivals and continence recovery were compared between the two procedures.

Results: Patient age, prostate-specific antigen (PSA) levels, clinical stages, and Gleason score were not significantly different between the two groups. There was no significant difference in PSM rates (25.8% vs. 33.7%, p = 0.13) or BCR-free survivals (p = 0.28) between cRARP and rsRARP in patients. When tumor was located in the anterior lesion in the prostatectomy pathology, rsRARP was associated with significantly higher PSM rates than cRARP (53.3% in rsRARP vs. 27.0% in cRARP, p = 0.0086), while BCR-free survival did not vary significantly (hazard ratio: 2.15, p = 0.11). When tumors were identified in the posterior in prostatectomy pathology, PSM rates (28.8% in rsRARP vs. 24.7% in cRARP, p = 0.59) or BCR-free survivals (hazard ratio: 0.78, p = 0.51) did not differ significantly between the two groups. rsRARP yielded superior continence recovery in all time points compared to cRARP, which was not affected by the pathological tumor location.

Conclusion: In posterior tumors, rsRARP results in similar oncological outcomes as cRARP with superior continence recovery, while in anterior tumors, rsRARP may associate with higher PSM rate, combined with improved continence recovery.

Keywords: Retzius-sparing RARP; anterior tumor; biochemical recurrence; incontinence; positive surgical margin.