AUA 2018: Conventional Robot-Assisted Radical Prostatectomy vs Retzius-Sparing Robot-Assisted Radical Prostatectomy
In a moderated poster presented at the American Urologic Association Annual Meeting, Dr. Kim and colleagues report a non-randomized, propensity-score matched analysis of patients undergoing conventional robotic assisted radical prostatectomy (cRARP) and a Retzius sparing approach (RS-RARP) at a single institution in Seoul, Korea. They examined rates and locations of positive surgical margins, as well as biochemical recurrence. Among their institutional dataset, the authors identified 1219 patients undergoing cRARP and 428 undergoing RS-RARP who did not receive neoadjuvant or adjuvant therapies and for whom complete data were available. They used a 1:1 propensity score matching approach to match these patients.
While overall rates of positive surgical margins were similar between the two approaches (9.3% for RS-RARP and 9.2% for cRARP), the anatomic location of the positive margins differed. Patients who underwent cRARP were more likely to have a positive margin in the posterolateral region (p=0.035) while those who underwent RS-RARP were more likely to have a positive margin in the anterior region (p=0.046). Biochemical recurrence rates were comparable between the approaches on both univariable and multivariable analyses.
In summary, while the overall rates of positive surgical margins ae not affected by the operative approach to RARP, anatomic locations of these margins differ. The location of these margins is associated with the more difficult aspects of dissection intraoperatively. There are a number of potential implications. First, for surgeons undertaking either or both approaches, these data help raise awareness of the regions in which positive margins are more likely. Therefore, operative approaches may be tailored to reduce this risk. Further, for surgeons who are comfortable with both approaches, it may be feasible to tailor the operative technique for any given patient on the basis of the location of their disease.
Presented By: Lawrence H C Kim
Co-authors: Ali Raheem, Glen D Santok, Kidon Chang, Trenton Lum, Byung Ha Chung, Young Deuk Choi, Koon Ho Rha
Written by: Christopher J.D. Wallis, Urology Resident, University of Toronto, Twitter: @WallisCJD at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA