The Efficiency and Safety of Transperitoneal versus Extraperitoneal Robotic-Assisted Radical Prostatectomy for Patients with Prostate Cancer: A Single Center Experience with 1-year Follow-up
5 January 2019
Purpose: Several studies have compared the short-term outcomes of extraperitoneal robot-assisted laparoscopic radical prostatectomy (EP-RALP) and transperitoneal RALP (TP-RALP). The study was designed to evaluate the long-term outcomes of the two methods.
Materials and Methods: A prospective, non-randomized study was conceived. The demographics and operative outcomes of patients with prostate cancer undergoing RALP from September 2016 to January 2017 at our center were included.
Results: A total of eighty-six patients were enrolled. Thirty-seven patients underwent EP-RALP, and forty-nine patients received TP-RALP. No significant difference was observed in age, body mass index, pathological T stage, pathological N stage, M stage, 2014 International Society of Urological Pathology group, comorbidities or American Society of Anesthesiologists score. A lower preoperative prostate-specific antigen (PSA) was detected in the EP-RALP group. No significant differences were observed in overall operation time, robotic console time, surgical margin status, postoperative hospitalization time, drop of hemoglobin and complications, except that patients with EP-RALP had a shorter time to first exsufflation after surgery than those with TP-RALP (41.35 vs. 51.80 h, P < .001). Postoperative PSA until 12 months was deemed comparable in both groups. Complete continence until 12 months after surgery was desirable but not significantly different between two groups (75.0% in EP- RALP vs. 86.7%. in TP-RALP, P = .179).
Conclusion: The long-term outcomes of EP-RALP were analogous to those of TP-RALP. Therefore, EP-RALP is an alternative approach for patients with localized prostate cancer.
Keywords: prostate cancer; robot-assisted prostatectomy; extraperitoneal approach; transperitoneal approach; enhanced recovery after surgery
- prostate cancer
- robot-assisted prostatectomy
- extraperitoneal apporaoch.
Hu JC, O'Malley P, Chughtai B, et al. Comparative Effectiveness of Cancer Control and Survival after Robot-Assisted versus Open Radical Prostatectomy. J Urol 2017;197:115-21.
Allan C, Ilic D. Laparoscopic versus Robotic-Assisted Radical Prostatectomy for the Treatment of Localised Prostate Cancer: A Systematic Review. Urol Int 2016;96:373-8.
Binder J, Kramer W. Robotically-assisted laparoscopic radical prostatectomy. BJU Int 2001;87:408-10.
Gettman MT, Hoznek A, Salomon L, et al. Laparoscopic radical prostatectomy: description of the extraperitoneal approach using the da Vinci robotic system. J Urol 2003;170:416-9.
Atug F, Castle EP, Woods M, et al. Transperitoneal versus extraperitoneal robotic-assisted radical prostatectomy: is one better than the other? Urology 2006;68:1077-81.
Capello SA, Boczko J, Patel HR, et al. Randomized comparison of extraperitoneal and transperitoneal access for robot-assisted radical prostatectomy. J Endourol 2007;21:1199-202.
Madi R, Daignault S, Wood DP. Extraperitoneal v intraperitoneal robotic prostatectomy: analysis of operative outcomes. J Endourol 2007;21:1553-7.
Chung JS, Kim WT, Ham WS, et al. Comparison of oncological results, functional outcomes, and complications for transperitoneal versus extraperitoneal robot-assisted radical prostatectomy: a single surgeon's experience. J Endourol 2011;25:787-92.
Jacobs BL, Montgomery JS, Dunn RL, et al. A comparison of extraperitoneal and intraperitoneal approaches for robotic prostatectomy. Surg Innov 2012;19:268-74.
Akand M, Erdogru T, Avci E, et al. Transperitoneal versus extraperitoneal robot-assisted laparoscopic radical prostatectomy: A prospective single surgeon randomized comparative study. Int J Urol 2015;22:916-21.
Horstmann M, Vollmer C, Schwab C, et al. Single-centre evaluation of the extraperitoneal and transperitoneal approach in robotic-assisted radical prostatectomy. Scand J Urol Nephrol 2012;46:117-23.
Lee JY, Diaz RR, Cho KS, et al. Meta-analysis of transperitoneal versus extraperitoneal robot-assisted radical prostatectomy for prostate cancer. J Laparoendosc Adv Surg Tech A 2013;23:919-25.
Smith JA. Jr., Tewari A. ROBOTICS IN UROLOGIC SURGERY. 1st ed. Philadelphia, PA: Elsevier; 2008.
Heidenreich A, Bastian PJ, Bellmunt J, et al. EAU guidelines on prostate cancer. Part II: Treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol 2014;65:467-79
Sugi M, Matsuda T, Yoshida T, et al. Introduction of an Enhanced Recovery after Surgery Protocol for Robot-Assisted Laparoscopic Radical Prostatectomy. Urol Int 2017;99:194-200.
Epstein JI, Egevad L, Amin MB, et al. The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma: Definition of Grading Patterns and Proposal for a New Grading System. Am J Surg Pathol 2016;40:244-52.
Bianco FJ, Albala DM, Belkoff LH, et al. A randomized, double-blind, solifenacin succinate versus placebo control, phase 4, multicenter study evaluating urinary continence after robotic assisted radical prostatectomy. J Urol 2015;193(4):1305-10.
- Abstract Viewed: 0 times
- Just Accepted/5475 Downloaded: 0 times