To investigate the curative effects of Retzius sparing robotic assisted laparoscopic radical prostatectomy(RARP) through anterior path.

From July 2015 to July 2017, 75 patients undergoing Retzius sparing RARP(Rs-RARP group) and 75 patients undergoing conventional anterior approach RARP(CA-RARP group) were retrospectively reviewed.Preoperative data of patients was collected as follows: age of (68.6±5.3) years, median prostate volume of 38.9 (20.6-60.1)m1, tPSA of (15.7±3.3)ng/ml, BMI of (25.2±3.6)kg/m², biopsy Gleason score of 3+ 3 in 24 cases, 3+ 4 in 28 cases, 4+ 3 in 23 cases, cTMN T_1c in 11 cases, T_2a-T_2b in 59 cases, T_2c in 5 cases, in Rs-RARP group; age of (69.6±5.6) years, median prostate volume of 38.3(18.4-59.8)ml, tPSA of (17.6±4.4) ng/ml, BMI of (27.5±2.7) kg/m², biopsy Gleason score of 3+ 3 in 29 cases, 3+ 4 in 26 cases, 4+ 3 in 20 cases, cTMN T_1c in 17 cases, T_2a-T_2b in 51 cases, T_2c in 7 cases, in CA-RARP group. The clinical data of the two groups, including operation time(OT), intraoperative blood loss, perioperative blood transfusion rate, 24h/1m/3m/6m/12m continence situation and erectile function recovery, and postoperative oncological results were analyzed statistically.

All cases were successfully performed robotically without conversion or major intraoperative or postoperative complications. For operative time, Rs-RARP group was (125.3±15.6)mins and CA-RARP group was (108.4±21.7) mins, and the difference was not statistically significant (P>0.05). For estimated blood loss (EBL), Rs-RARP group was (106.1±10.3)ml, with perioperative blood transfusion in 2 cases(2.67%), and CA-RARP group was (82.2±18.4)ml, with perioperative blood transfusion in 1 cases(1.33%). The Rs-RARP group had more EBL than the CA-RARP group(P<0.05). No difference was found in perioperative blood transfusion rate(P>0.05). The postoperative oral intake time was (1.5±0.6) d, postoperative hospital stay was (8.0±1.2) d, total hospitalization expense was (58.4±13.2) thousand Yuan, and there were 5 cases (6.67%) with postoperative complications in Rs-RARP group, and was (2.0±0.6) d, (9.0±1.8) d, (60.2±16.4) thousand Yuan and 3 cases (4.00%) in corresponding items in CA-RARP group. No significant difference was found in the above mentioned parameters (all P>0.05). Postoperative pathology confirmed pT_1c of 18 cases, T_2a-T_2b of 52 cases, and pT_2c of 5 cases in Rs-RARP group and pT_1c of 12 cases, T_2a-T_2b of 56 cases, pT_2c of 7 cases in CA-RARP group (P>0.05). There was no significant difference between Rs-RARP and CA-RARP groups in the surgical positive margin (5 cases vs. 4 cases, P>0.05). No tumor recurrence appeared for all cases (tPSA<0.2 ng/m1) during 12 months follow-up.The continence rate for Rs-RARP group and CA-RARP group were 84.0% (63/75) vs. 28.0% (21/75) (24h postoperatively), 90.7% (68/75) vs. 46.7% (35/75) (1 month postoperatively), 93.3% (70/75) vs. 57.3% (43/75) (3 months postoperatively), 96.0% (72/75) vs. 89.3% (67/75) (6 months postoperatively) and 100% (75/75) vs. 96.3% (72/75) (1 year postoperatively). Rs-RARP group showed superiority in continence recovery at 24 h and 1, 3 months postoperatively(all P<0.05), but no statistical differences at 6, 12 months postoperatively(all P>0.05). On erectile function, Rs-RARP group was significantly better than the conventional group at 1, 3, 6, 12 months postoperatively in≤75-year-old patients(all P<0.05). But in>75-year-old patients, two groups had no difference during the follow-up (all P>0.05).

Retzius sparing RARP through anterior path can treat early and intermediate stage prostate cancer effectively, and continence and erectile function recovered shortly.

Prostatic neoplasms; Robot; Laparoscopy; Retzius sparing; Radical prostatectomy