Perioperative and short‐term outcomes of Retzius‐sparing robot‐assisted laparoscopic radical prostatectomy stratified by gland size

Abstract

Objective To investigate the effect of preoperative prostate volume ( PV ) on the perioperative, continence and early oncological outcomes among patients treated with Retzius‐sparing robot‐assisted laparoscopic radical prostatectomy ( RS ‐ RALP ). Patients and Methods This is a retrospective analysis of 294 patients with organ‐confined prostate cancer treated with RS ‐ RALP in a high‐volume centre from November 2012 to February 2015. Patients were divided into three groups based on their transrectal ultrasonography estimated PV as follows: group 1, <40 mL (231 patients); group 2, 40–60 mL (47); group 3, >60 mL (16). Perioperative, oncological, and continence outcomes were compared between the three groups. Results The median [interquartile range ( IQR )] PV for each group was; 26.1 (22–31) mL, 45.9 (41–50) mL, and 70 (68–85) mL. Blood loss was higher in group 3 compared to groups 2 and 1; at a median ( IQR ) of 475 (312–575) mL, 200 (150–400) mL, and 250 (150–400) mL, respectively ( P = 0.001). The intraoperative transfusion rate was higher in group 3 patients ( P = 0.004), while the complication rate did not differ ( P = 0.05). The console time was slightly higher but was not statistically significant in group 3 compared to groups 2 and 1; at a mean ( sd ) of 100 (35) min, 92 (34.4) min, and 93 (24.8) min, respectively ( P = 0.70). Biochemical recurrence and the continence rate did not differ between the three groups ( P = 0.89 and P = 0.25, respectively). Conclusion RS ‐ RALP is oncologically and functionally equivalent for all prostate sizes but technically demanding for larger prostates. We therefore recommend that surgeons initiate their RS ‐ RALP technique with smaller prostates.