MP19-15: Retzius-Sparing Robotic Assisted Radical Prostatectomy Leads to Improved Functional Outcomes Compared to Standard Robotic Assisted Radical Prostatectomy Without Compromise of Oncologic Outcomes

John W. O'Neill, Filipe LF. Carvalho, Harry Lee, Jillian Egan, Nathan Shaw, John H. Lynch, Sarah Holzman, Kenneth Witmer, Collier Wright, Keith J. Kowalczyk

Introduction: Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) is reported to improve urinary functional outcomes faster over standard RARP.  However, there are reports of increased positive surgical margins in the early portion of the surgical learning curve. We report initial single-surgeon outcomes of RS-RARP compared with the same surgeon’s recent standard robot-assisted radical prostatectomy (RARP) outcomes.

Methods: Perioperative and long-term outcomes were gathered in a prospectively collected database by research assistants not involved in clinical care. Long-term functional outcomes were assessed using the Expanded Prostate Cancer Index-Clinical Practice (EPIC-CP) questionnaire. Time to continence (defined as both 0 and 0-1 safety pad), potency (erection suitable for sexual activity), and overall EPIC-CP QOL scores were compared between techniques by two-tailed T-test assuming unequal variance.

Results: 52 RS-RARP vs. 50 standard RARP were compared.  Perioperatively, estimated blood loss was lower for RS-RARP vs. RARP (169 vs 273 mL, p=0.002).  There were no differences in non-focal positive surgical margins (9.4% vs. 12.0%, p=0.213) or biochemical recurrence (17.3% vs 22%, p=0.555).  Median time to continence was shorter for RS-RARP vs RARP (0-1 pad: 48 vs 72 days, p=0.001; 0 pads: 82 vs. 151 days, p<0.001). Although there were no differences in overall potency (62.7% vs. 62%, p=0.939) or continence (94.2% vs. 88%, p=0.272), EPIC-CP urinary score for RS-RARP were significantly better at 3 and 9 months, while sexual and overall scores were better at 9 months.  Unlike RARP, all EPIC-CP scores for men undergoing RS-RARP returned to baseline after 12 months.

Conclusions: RS-RARP leads to a significantly faster recovery of continence compared to RARP without  compromising oncologic outcomes. Additionally, there may be improved sexual function and overall quality of life in men undergoing RS-RARP, as most men undergoing RS-RARP had return to baseline EPIC-CP QOL scores after 12 months.  While these outcomes are promising, longer-term follow-up is necessary to ensure oncologic efficacy. Source of

Funding: Conflict of Interest and Disclosure Statement:  There are no disclosures among all authors.