Complications of the first 500 extra-peritoneal robot-assisted radical prostatectomy (EP-RARP) cases in an Italian medium volume centre.

Abstract

The aim of this study was to evaluate the prevalence and the predictors of postoperative complications in Extra-Peritoneal Robot Assisted Radical Prostatectomy (EP-RARP), and also to test the influence of the surgeons skills on perioperative variables and complications. Data from the first consecutive 500 patients who underwent EP-RARP were prospectively collected from December 2004 and June 2014. Mean follow-up was 55.7 months. Standardized criteria were used to report the procedural complications. Independent predictors of complications were examined through multivariate analysis using logistic regression models. The influence of the surgeons learning curves on perioperative variables was tested. One hundred fifty (30%) patients experienced complications, with 104 medical complications in 95 (19%) patients and 89 surgical complications in 72 (14.4%) patients. There were 17 major (Clavien IIIa-b) surgical complications in 15 (3%) patients, with no mortality. Multivariate analysis showed that Charlson score [odds ratio: 1.514; 95% confidence interval (95% CI): 1.145-2.002; p = 0.0003] and gastroenteric diseases (odds ratio 1.108; 95% CI: 1.108-4.560; p = 0.003) were the best predictors of medical complications and cT1c/T2a stages (odds ratio: 2.697; 95% CI: 1.319-5.514; p<0.0001) and blood transfusions (odds ratio: 3.328; 95% CI: 1.471-7.530; p<0.0001) were strongly related to surgical complications. Finally, the statistical evaluation showed that all considered perioperative variables, except the complication rates, improved during the study period. With a precise report of the morbidity related to EP-RARP, this study showed that complications were relatively frequent, but their severity was generally low.