Robotic radical prostatectomy: analysis of midterm pathologic and oncologic outcomes: A historical series from a high-vo
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and Other Interventional Techniques
Robotic radical prostatectomy: analysis of midterm pathologic and oncologic outcomes: A historical series from a high‑volume center Anastasios D. Asimakopoulos1,2 · Filippo Annino1,3 · Camille Mugnier1 · Laurent Lopez1 · Jean Luc Hoepffner1 · Richard Gaston1 · Thierry Piechaud1 Received: 13 July 2020 / Accepted: 15 November 2020 © The Author(s) 2020
Abstract Background Identifying predictors of positive surgical margins (PSM) and biochemical recurrence (BCR) after radical prostatectomy (RP) may assist clinicians in formulating prognosis. Aim of the study was to report the midterm oncologic outcomes, to identify the risk factors for PSM and BCR and assess the impact of the PSM on BCR-free survival following robot-assisted laparoscopic radical prostatectomy (RALP). Methods From 2005 to 2010, 1679 consecutive patients underwent transperitoneal RALP. Data was retrospectively collected by an independent statistical company and analyzed in 2014. Median postoperative follow-up was 33.5 mo. BCR was defined as any detectable serum prostate-specific antigen (PSA) ≥ 0.2 ng/mL in two consecutive measurements. BCR-free survival was estimated using the Kaplan–Meier method. Univariate and multivariate analysis were applied to identify risk factors for PSM and BCR. Results In pN0/pNx cancers, pathologic stage was pT2 in 1186 patients (71.8%), pT3 in 455 patients (27.6%), and pT4 in 11 patients (0.6%). PSM rate was 17.4% and 36.9% of pT2 and pT3 cancers, respectively. Pathologic Gleason score was 7 in 42.1%, 53% and 4.9% of the patients, respectively. Overall BCR-free survival was 73.1% at 5 years; the 5-year BCR-free survival was 87.9% for pT2 with negative surgical margins. PSA, Gleason score (both bioptic and pathologic), pathologic stage (pT) and surgeon’s volume were significant independent predictors of PSM. PSA, pathologic Gleason score, pT and PSM were significant independent predictors of BCR-free survival. Seminal vesicle-sparing, nerve-sparing approach and the extent of nerve-sparing (intra vs interfascial dissection) did not negatively affect margin status or BCR rates. Conclusions PSMs are a predictor of BCR. Being the only modifiable factor influencing the PSM rate, surgical experience is confirmed as a key factor for high-quality oncologic outcomes. Keywords Cancer of prostate · Robotics · Prostatectomy · Laparoscopy · Positive surgical margin Despite the current, conflicting evidence regarding the benefit of radical prostatectomy (RP) over deferred treatment in both the overall and cancer-specific survival of patients affected by localized prostate cancer (PCa), RP still remains a mainstay of treatment [1]. Robot-assisted laparoscopic RP
* Anastasios D. Asimakopoulos [email protected] 1
Department of Urology, Clinique Saint Augustin, Bordeaux, France
2
Department of Surgical Sciences, Unit of Urology, Fondazione PTV Policlinico Tor Vergata, Rome, Italy
3
Unit of Urology, Ospedale San Donato, Arezzo, Italy
(RALP) has become the established state-of-th
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