Positive Surgical Margins Rate of Retzius-Sparing Robot-Assisted Radical Prostatectomy in a Contemporary, Unselected Cohort.

Abstract

Our aim was to report the positive surgical margin (PSM) rate of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) in an unselected, real-life cohort of patients treated at a fellowship-training urological department. Demographic, clinical and pathological data of 529 consecutive patients who underwent RS-RARP between January 2017 and December 2020 were collected prospectively and analyzed retrospectively in a hospital-approved audit in a European Association of Urology Robotic Urology Section (ERUS)-approved fellowship program. Overall PSM rates were reported for the entire cohort and for pT2 and pT3 patients separately. We defined clinically significant PSM as any length of >3 mm or multiple PSMs regardless of length. Median patient age was 64 years. More than 97% of the patients had intermediate or high-risk disease. The pathological stages were T2 (66.5%) and T3 (33.5%). Overall PSM was reported in 13.3% of pT2 patients and 28.9% of pT3 patients. Clinically significant PSM was reported in 43 patients (8.1%), and most of them (27 patients) had pT3 disease. Only 2.6% positive margins were reported at the apex and 0.7% on the anterior surface and bladder neck. Immediate continence (defined as no pads or 1 safety pad a day) rate was 65%. PSM rates of RS-RARP are acceptable and are higher in pT3 disease compared to pT2.