Outcomes of robot-assisted laparoscopic radical prostatectomy in high-risk prostate cancer patients: experience in 34 patients with oncologic and functional outcomes

Abstract

Introduction & Objectives: We report outcomes of robot-assisted laparoscopic radical prostatectomy (RARP) and extended pelvic lymph node (LN) dissection (ePLND) in high-risk prostate cancer (HRPCa) classified due to D'Amico risk group with minimum 1-year followup. Material & Methods: A total of 34 patients who had at least one preoperative HRPCa feature underwent RARP were included. LN dissection was performed in patients who had >5% of LN involvement probability due to Partin's tables. Mean patient age and preoperative serum PSA were 62.6±6.4 years and 12.2±9.1 ng/ml, respectively. Preoperatively, 2 (5.8%), 1 (2.9%), 11 (32.3%), 3 (8.8%) and 17 (50%) patients had prostate biopsy Gleason scores (GS) 5+4, 4+5, 4+4, 3+5 and <8, respectively. No patient had GS 5+5 or 5+3 disease. Bilateral neurovascular bundle (NVB) sparing, unilateral NVB-sparing and non-NVB-sparing surgery were performed in 16 (%47), 5 (%15) and 13 (%38) patients, respectively. Results: Mean console time, intraoperative blood loss, duration of hospital stay and urethral catheter removal time were 162.1±64.4 minutes, 232.2±255.1 cc, 4.1±2.1 days and 12.6±6.2 days, respectively. During perioperative period (0-30 days), 4 minor (prolonged ileus [n=1], prolonged anastomotic leakage [n=1], prolonged lymphatic drainage [n=1] and urinary tract infection [n=1]) and 2 major (intraoperative bladder injury [n=2] that were repaired intraoperatively) complications occurred due to modified Clavien classification. No complication was detected during postoperative 31-90 days. Postoperative pathologic stages included pT0, pT2a, pT2b, pT2c, pT3a and pT3b disease in 2 (5.8%), 5 (14.7%), 3 (8.8%), 6 (17.6%), 10 (29.4%) and 8 (23.5%) patients, respectively. Postoperative GS included 3+3=6 (n=7, 20.5%), 3+4=7 (n=10, 29.4%), 4+3=7 (n=6, 17.6%), 4+4=8 (n=2, %5.8), 5+3=8 (n=1, 2.9%), 3+5=8 (n=1, 2.9%), 4+5=9 (n=3, 8.8%), 5+4=9 (n=1, 2.9%) and 5+5=10 (n=1, 2.9%). No malignancy was detected in 2 (5.8%) patients' pathologic specimens. Positive surgical margin (SM) rate was 32.3% (2.9% in pT2 and 29.4% in pT3 disease). Of the patients, 17 (50%) underwent ePLND. Mean LN yield was 11.8±8.3 (range, 3- 37). One patient had LN metastasis. Of the patients, 4 (11.8%) received adjuvant radiotherapy therapy (ART) alone, 4 (11.8%) received hormone therapy (HT) alone and 4 (11.8%) received ART+HT postoperatively. Mean follow-up was 27.8±11.1 months. Biochemical recurrence was detected in 9 (26.4%) patients. Of the 34 patients with 1- year follow-up, 17 (50%) were fully continent (0 pad/day), 6 (17.7%) wore a safety pad/day, 6 (17.7%) wore 1 pad/day, 3 (8.8%) wore 2 pads/day and 2 (5.9%) wore >2 pads/day. Of the 24 patients with no preoperative erectile dysfunction (ED), 15 (44.1%) had no ED at a mean follow-up of 1-year. Trifecta and pentafecta rates were 38% and 26%, respectively. Conclusions: Due to our experience, RARP and ePLND in HRPCa is a safe procedure with satisfactory oncologic and functional outcomes.