Technical Refinements in Superextended Robot-assisted Radical Prostatectomy for Locally Advanced Prostate Cancer Patients at Multiparametric Magnetic Resonance Imaging

• Published in: European urology Vol. 80; no. 1; pp. 104 - 112
• Main Authors: Mazzone, Elio, Dell’Oglio, Paolo, Rosiello, Giuseppe, Puliatti, Stefano, Brook, Nicholas, Turri, Filippo, Larcher, Alessandro, Beato, Sergi, Andras, Iulia, Wisz, Pawel, Pandey, Abhishek, De Groote, Ruben, Schatteman, Peter, De Naeyer, Geert, D’Hondt, Frederiek, Mottrie, Alexandre
• Format: Journal Article
• Language: English
• Published: Switzerland Elsevier B.V 01.07.2021
• Subjects: Humans; Locally advanced; Male; Margins of Excision; Multiparametric Magnetic Resonance Imaging; Postoperative Complications - etiology; Preoperative magnetic resonance imaging; prostate cancer; Prostatectomy - adverse effects; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - surgery; Robot-assisted radical prostatectomy; Robotic Surgical Procedures - adverse effects; Robotics; Seminal Vesicles; Seminal vesicles invasion; Surgical technique; Treatment Outcome; Seminal vesicles invasion; prostate cancer; Robot-assisted radical prostatectomy; Surgical technique; Preoperative magnetic resonance imaging; Locally advanced
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2020.09.009

The feasibility and efficacy of robot-assisted radical prostatectomy (RARP) in locally advanced prostate cancer (PCa) patients with iT3 lesion at magnetic resonance imaging (MRI) are currently not explored. To describe our revised RARP technique (ie, superextended RARP [SE-RARP]) for PCa patients with posterior iT3a or iT3b at MRI. Data from 89 patients with posterior iT3a or T3b disease who underwent SE-RARP at a single high-volume centre between 2015 and 2018 were analysed. RARP was performed using a DaVinci Xi system. The surgical approach provided an inter- or extrafascial RARP where Denonvilliers’ fascia and perirectal fat were dissected free and left on the posterior surface of the seminal vesicles. Perioperative outcomes, and intra- and postoperative complications were assessed. Postoperative outcomes were assessed in patients with complete follow-up data (n = 78). Biochemical recurrence (BCR) was defined as two consecutive prostate-specific antigen values of ≥0.2 ng/ml. Urinary continence (UC) recovery was defined as the use of zero or one safety pad. Kaplan-Meier and multivariable Cox regression models were used. The median operative time, blood loss, and length of stay were 204 min, 300 ml, and 5 d, respectively. The median bladder catheterisation time was 5 d. Overall, 28%, 28%, and 27% of patients had pathological grade group (GG) 4–5, pT3b, and positive surgical margins (PSMs), respectively. Three patients (3.4%) experienced intraoperative complications. Among patients with available follow-up data (n = 78), 14 (18%) experienced 30-d postoperative complications. The median follow-up was 19 mo. Overall, 11 patients received additional treatment. At 2 yr of follow-up, BCR-free and additional treatment–free survival were 55% and 66%, respectively. Pathological GG 4–5 (hazard ratio [HR] 3.2) and PSM (HR 5.8) were independent predictors of recurrence, as well as of additional treatment use (HR 5.6 for GG 4–5 and 5.2 for PSM). The 1-yr UC recovery was 84%. We presented our revised RARP technique applicable to patients with posterior iT3a or iT3b at preoperative MRI. This technique is associated with good morbidity and continence recovery rates, and might guarantee biochemical control of the disease and postpone the use of additional treatments in patients with low-grade and negative surgical margins. A revised robot-assisted radical prostatectomy technique applicable to prostate cancer patients with posterior iT3a or iT3b lesion at magnetic resonance imaging was described. This novel technique is feasible and safe in expert hands. In this study, we presented our revised robot-assisted radical prostatectomy technique applicable to patients with posterior T3a or T3b at magnetic resonance. This novel technique is feasible and safe in expert hands, and might achieve a complete therapeutic effect without the need for additional treatments at midterm follow-up in patients with low-grade and negative surgical margins.