Abstract
ABSTRACTBackground:To date, few series on robot-assisted radical prostatectomy (RARP) in kidney transplant recipients (KTRs) have been published.Purpose:To report the experience of two referral centers adopting two different RARP approaches in KTRs. Surgical, oncological and functional results were primary outcomes evaluated in the study.Material and methods:We retrospectively analyzed data from 9 KTRs who underwent transperitoneal RARP or Retzius-sparing RARP for PCa from October 2012 to April 2016. Data were reported as median and interquartile range (IQR). Pre- and postoperative outcomes were compared by non-parametric Wilcoxon signed-rank test. Significant differences were accepted when p ≤ 0.05. Overall survival was assessed using Kaplan-Meier method.Results:Four KTRs underwent a T-RARP and 5 a RS-RARP. Patient median age was 60 (56-63) years. Charlson comorbidity index was 6 (5-6). Preoperative median PSA was 5.6 (5-15) ng / mL. Preoperative Gleason score (GS) was 6 in 5 patients, 7 (3 + 4) in 3, and 8 (4 + 4) in one. Pre- and postoperative creatinine were 1.17 (1.1; 1.4) and 1.3 (1.07; 1.57) mg / dL (p = 0.237), while eGFR was 66 (60-82) and 62 (54-81) mL / min / 1.73m2 (p = 0.553), respectively. One (11.1%) Clavien-Dindo grade II complication occurred. Two extended template lymphadenectomies were performed, both with nodal invasion. These two patients experienced a biochemical recurrence and were subjected to RT. Two patients (22.2%) had PSMs. Median follow-up was 42 months. Seven patients (77.8%) were continent, 5 (55.6%) were potent. Two (22.2%) patients died during follow-up for oncologic unrelated causes.Conclusions:Our series suggests that both RARP approaches are safe and feasible techniques in KTRs for PCa.
Highlights
In the last decades, a longer and qualitatively better life has been granted to kidney transplant recipients (KTRs) [1].a higher rate of carcinogenesis has been described with an increase of the risk of malignant transformation by three to five folds compared to age-matched controls [2].ibju | robot-assisted radical prostatectomy (RARP) in kidney transplant recipientsIn these patients, prostate cancer (PCa) represents the most common tumor among genitourinary malignancies [3]
Among the 5 patients diagnosed with a Gleason score (GS) of 6 (3 + 3), 2 had oncologic characteristic adequate for active surveillance (AS) according to PRIAS criteria [21], but both refused the surveillance program
The current study’s results suggest that both RARP approaches adopted at our institutions may be safely applied in KTR patients
Summary
Ibju | RARP in kidney transplant recipients. In these patients, prostate cancer (PCa) represents the most common tumor among genitourinary malignancies [3]. Different options have been proposed for the treatment of PCa in KTRs, such as surgery, radiotherapy and brachytherapy [7], radical prostatectomy remains the preferred option. Few series on robot-assisted radical prostatectomy (RARP) in kidney transplant recipients (KTRs) have been published. Purpose: To report the experience of two referral centers adopting two different RARP approaches in KTRs. Surgical, oncological and functional results were primary outcomes evaluated in the study. Two extended template lymphadenectomies were performed, both with nodal invasion These two patients experienced a biochemical recurrence and were subjected to RT.
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