Retzius-sparing may be better than conventional RARP

Retzius-sparing robotic-assisted radical prostatectomy (rsRARP) leads to better continence recovery than conventional RARP (cRARP), a new study has found. Meanwhile, in anterior tumours, rsRARP is associated with higher positive surgical margins (PSM).

The study included 317 patients, most of whom underwent cRARP (n=228), while 89 received rsRARP. Study outcomes included PSM rates, continence recovery, and biochemical recurrence (BCR)-free survival rates, compared between treatment arms.

Overall, rsRARP had comparable oncological performance as cRARP, resulting in similar PSM rates (33.7 percent vs 25.8 percent, respectively; p=0.13) and BCR-free survival (p=0.28). In anterior tumours, however, rsRARP returned significantly higher PSM rates than the conventional procedure (53.3 percent vs 27.0 percent; p=0.0086), though no such difference in BRC-free survival was documented (hazard ratio [HR], 2.15; p=0.11).

RsRARP continued to perform as well as cRARP in posterior tumours, with corresponding PSM rates of 28.8 percent and 24.7 percent (p=0.59). BRC-free survival was also statistically similar in both arms (HR, 0.78; p=0.51).

Both interventions were also comparably safe, with no significant differences in operative time (p=0.08), estimated blood loss (p=0.92), catheter placement time (p=0.61), hospitalization duration (p=0.17), and postoperative complications (p=0.18).

Of note, despite the generally comparable profiles between rsRARP and cRARP, the former led to significantly better continence recovery at all time points. At 1 month, for example, only 27.3 percent of csRARP recipients needed one safety pad or less, as opposed to 77.9 percent of rsRARP comparators. Such a pattern continued until 12 months, when 41.5 percent of cRARP patients needed zero pads, as compared with 75.3 percent of the rsRARP group.