Retzius-sparing robotic-assisted laparoscopic radical prostatectomy: Racial considerations for 250 consecutive cases.

Abstract

e17546 Background: To report the functional and oncologic outcomes of a cohort of 250 consecutive prostate cancer patients undergoing a Retzius-sparing approach and to assess for racial differences in continence outcomes. Methods: This was a prospective, single-center, case series of 250 consecutive prostate cancer patients who underwent a Retzius-sparing robotic assisted laparoscopic radical prostatectomy by a single surgeon between May 2015 and April 2019.Our primary objective was to describe post-operative continence outcomes of patients undergoing this technique. Results: Median follow up was 24.0 months [Interquartile range (IQR) 18.0-30.0 months]. Median age and body mass index were 62.0 years (IQR 57.0-67.0) and 29.0 kg/m 2 (IQR 26.0-33.0), respectively. Median PSA was 8.22 ng/ml (IQR 5.74-13.31). 84.8% of patients were intermediate or high-risk pre-operatively. 96.0% had Gleason Score 7 or worse disease on final pathologic analysis. Positive margin incidence was 18.1% and 44.4% in patients with pT2 and pT3 disease, respectively. Immediate continence (i.e. continence achieved within one moth post-operatively) was achieved in 45.0% of patients. One-year continence rate was 92.0%. Caucasian patients experienced earlier return of continence (77% versus 65% at 3 months) compared to African American patients. IPSS scores gradually improved from 8.0 pre-operatively to 4.0 one year later. Median PSA level was 0.01 ng/ml (IQR 0.01-9.01) post-operatively. Conclusions: Retzius-sparing robotic assisted laparoscopic radical prostatectomy is an oncologically safe surgical technique with excellent short and long-term continence outcomes.