Evaluate the safety, feasibility and efficiency of robot-assisted radical prostatectomy (RARP) in kidney transplant recipients, performed in high-volume French referral centres, and describe intra- and postoperative, oncological and functional outcomes.
A multicentre study was conducted on prospective RARP databases from 5 centres between 2008 and 2017. We retrospectively identified a first group (G1) of transplant patients. The following data were collected: age, body mass index, prostate-specific antigen, ISUP score, TNM stage, stratification according to d'Amico, renal function, renal disease, time between renal transplant and prostate cancer (PCa), operating time, bleeding, pre- and postoperative complications (according to Clavien). Group 1 data were matched with a second group (G2) of nontransplanted PTRA patients.
A total of 321 patients were included (G1 N = 39 and G2 N = 282). The median operating time was 180 minutes (interquartile range 125-227) for G1 and 150 minutes (120-180) in G2 (P = 0.0623) and the median bleeding volume was 150 mL (150-400) and 250 mL (175-400), respectively (P = 0.1826). No grafts were damaged by RARP. Postoperative complication rate was significantly higher in G1: 51.2% vs. G2: 8.2% with a majority of minor complications (41%) according to Clavien Dindo (P < 0.001). Pathological assessment was as follows in G1: T2 = 28 (71.8%), T3 = 11 (28.2%), and G2: T2 = 206 (73.3%), T3 = 75 (26.7%) (P = 0.77). Postoperative ISUP scores were mainly grade 1: G1 = 14 (35.9%) vs. 99 (35.2%) in G2 and grade 2: respectively 18 (46.1%) 94 (33.5%). The rate of positive surgical margins was comparable in both groups: 13.2% for transplant patients vs. 18.1% (P = 0.65). Renal function was not significantly different at one year (P = 0.07). The median follow-up was 47.9 months (42.3; 52.5).
RARP is conceivable to treat localized prostate cancer in kidney transplant recipients. This procedure does not appear to have any negative impact on graft renal function and cancer prognosis.
Urologic oncology. 2020 Jan 13 [Epub ahead of print]
Margaux Felber, Sarah J Drouin, Pietro Grande, Christophe Vaessen, Jerome Parra, Benoit Barrou, Xavier Matillon, Sebastien Crouzet, Quentin Leclerc, Jerome Rigaud, Thomas Prudhomme, Nicolas Doumerc, Sebastien Bergerat, Herve Lang, Charles Laine, Grégoire Robert, Aurélien Gobert, Benjamin Granger, Morgan Rouprêt
Department of Urology, Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Urology, Hôpital Pitié-Salpêtrière, F-75013 Paris, France., Department of Urology, Hospices Civils de Lyon, Lyon, France., Department of Urology, Centre Hospitalier Universitaire de Nantes, Nantes Cedex 01, France., Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, Toulouse Cedex, France., Department of Urology, Hôpital Civil, Strasbourg, France., Department of Urology, Andrology and Renal Transplantation, GH Pellegrin Tripod, Bordeaux, France., Department of Biostatistics, Groupe Hospitalo-Universitaire Est, Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France., Department of Urology, Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Urology, Hôpital Pitié-Salpêtrière, F-75013 Paris, France. Electronic address: .