Retzius-sparing robot-assisted radical prostatectomy deliver satisfactory positive surgical margin rate

The rates of positive surgical margin (PSM) with Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) are acceptable and higher in pT3 disease than in pT2, according to a study.

In this study, the authors aimed to report the PSM rate of RS-RARP in an unselected, real-life cohort of patients treated at a fellowship-training urological department. They prospectively collected and retrospectively analysed demographic, clinical, and pathological data of consecutive patients who underwent RS-RARP between January 2017 and December 2020 in a European Association of Urology Robotic Section-approved fellowship program.

Overall PSM rates were reported for the entire cohort as well as for pT2 and pT3 patients separately. Clinically significant PSM was defined as any length of >3 mm or multiple PSMs regardless of length.

A total of 529 patients (median age 64 years) were included in the analysis, of whom >97 percent had intermediate- or high-risk disease. Majority of the patients (66.5 percent) had a T2 pathological stage, while the rest had T3 (33.5 percent). Overall PSM was reported in 13.3 percent and 28.9 percent of pT2 and pT3 patients, respectively.

Forty-three patients (8.1 percent) showed clinically significant PSM, most of whom (n=27) had pT2 disease. Only 2.6 percent positive margins were reported at the apex and 0.7 percent on the anterior surface and bladder neck. In addition, the rate of immediate continence (defined as no pads or one safety pad a day) was 65 percent.