Laparoscopic Versus Robot-assisted Bilateral Nerve-sparing Radical Prostatectomy: Comparison of Pentafecta Rates for a Single Surgeon

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2013 Jun 29

PMID 23807752

Citations 18

Authors

Anastasios D Asimakopoulos

Roberto Miano

Nicola Di Lorenzo

Enrico Spera

Giuseppe Vespasiani

Camille Mugnier

Affiliations

Soon will be listed here.

Abstract

Background: This study aimed to compare the pentafecta rates between laparoscopic radical prostatectomy (LRP) and robot-assisted radical prostatectomy (RALP) and to identify prognostic factors predicting the pentafecta for each technique.

Methods: This prospective comparative study enrolled 248 consecutive male patients 70 years of age or younger with clinically localized prostate cancer [PCa: age ≤ 70 years, prostate-specific antigen (PSA) ≤ 10 ng/ml, biopsy Gleason score ≤ 7] who were fully continent, potent, and candidates for bilateral nerve-sparing (BNS) LRP or RALP. The pentafecta rates between LRP and RALP were compared. A logistic regression model was created to evaluate independent factors for achieving pentafecta.

Results: In the final analysis, 91 LRP and 136 RALP patients were evaluated. The median follow-up period was 21 months for the 91 LRP patients and 18 months for the 136 RALP patients (p = 0.07). Of the 227 patients, 87 reached pentafecta [25 LRP patients (27.5 %) vs 62 RALP patients (45.6 %), p = 0.006]. Of the 140 patients who failed pentafecta, 90 (64.3 %) missed a single parameter. In these cases, erectile deficit was the leading cause of pentafecta failure, with a significant [corrected] difference between groups (80 % LRP cases that missed potency recovery [corrected] vs 53.3 % RALP, p = 0.007). Lower age, lower pathologic stage, and RALP are significantly associated with pentafecta as independent factors. For the pT3 disease, the two techniques did not differ significantly.

Conclusions: Patients submitted to BNS RP have low possibilities of achieving pentafecta. Use of the robotic platform by a single surgeon significantly enhances the possibility of achieving pentafecta independently of age and pathologic stage. Potency was the most difficult outcome to reach after surgery, and it was the main factor leading to pentafecta failure. LRP and RALP provide equivalent pentafecta rates for the pT3 disease and similar "tetrafecta" outcomes when potency recovery is not included among the postoperative expectations of the patient.

Citing Articles

Long-Term Oncological Outcomes after Nerve-Sparing Robot-Assisted Radical Prostatectomy for High-Risk Localized Prostate Cancer: A Single-Center, Two-Arm Prospective Study.

Spirito L, Chessa F, Hagman A, Lantz A, Celentano G, Sanchez-Salas R Diagnostics (Basel). 2024; 14(8).

PMID: 38667449 PMC: 11049337. DOI: 10.3390/diagnostics14080803.

Influence of operative time and blood loss on surgical margins and functional outcomes for laparoscopic versus robotic-assisted radical prostatectomy: a prospective analysis.

Salciccia S, Rosati D, Viscuso P, Canale V, Scarrone E, Frisenda M Cent European J Urol. 2022; 74(4):503-515.

PMID: 35083069 PMC: 8771133. DOI: 10.5173/ceju.2021.0177.

Prospective comparative trial on nerve-sparing radical prostatectomy using a robot-assisted versus laparoscopic technique: expectation versus satisfaction and impact on surgical margins.

Sciarra A, Frisenda M, Maggi M, Magliocca F, Ciardi A, Panebianco V Cent European J Urol. 2021; 74(2):169-177.

PMID: 34336234 PMC: 8318028. DOI: 10.5173/ceju.2021.0017.R3.

Nerve-sparing robot-assisted radical prostatectomy: Current perspectives.

Kumar A, Patel V, Panaiyadiyan S, Bhat K, Moschovas M, Nayak B Asian J Urol. 2021; 8(1):2-13.

PMID: 33569267 PMC: 7859364. DOI: 10.1016/j.ajur.2020.05.012.

Outcomes of Minimally Invasive Radical Prostatectomy-a Contemporary Review.

Bhat K, Raghunath S, Srivatsa N, Tejus C, Vishruth K, Kumar R Indian J Surg Oncol. 2020; 11(4):580-588.

PMID: 33299276 PMC: 7714884. DOI: 10.1007/s13193-020-01125-3.

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