A Randomized Controlled Trial Comparing Retzius-sparing Robot-assisted Laparoscopic Radical Prostatectomy And Conventional Robot-assisted Laparoscopic Radical Prostatectomy

Objective:To compare the postoperative outcomes and early function recovery between conventional robotic-assisted laparoscopic radical prostatectomy?RARP?and retzius-sparing robotic-assisted laparoscopic radical prostatectomy?RSRARP?.Methods:A total of 80 patients with prostate cancer who were randomized?randomized block design?to receive either retzius-sparing robotic-assisted laparoscopic radical prostatectomy?n=40?or robotic-assisted laparoscopic radical prostatectomy?n=40?were included in the study.The study was approved by the ethics committee and registration?ChiCTR-INR-17011743?as a single center randomized controlled trial.We recorded the age,BMI,prostate volume,tPSA,urinary domain of EPIC,sexual domain IIEF-5,ECOG,pathological result,clinical stage before operation and preserved the patient's biological sample.Then,patients were taken different treatment according to the results of randomized block design.We reviewed console time,estimated blood loss,the rate of leakage,blood transfusion and infection,complications,average daily drainage,albumin,pathological result,continence,urinary domain of EPIC,sexual domain of IIEF-5 and tPSA one month,two months and three months after operation.All data were analyzed to study the differences in postoperative outcomes,early function between two groups and influences on RSRARP.Results:All 80 cases were successfully performed robotically.Mean operation time was significantly more in conventional RARP group than in RSRARP group[?217.7±48.3?min vs?189.4±43.2?min,P<0.05)].Postoperative data of patients in conventional RARP group[estimated blood loss 300 ml?100⁶00 ml?,average daily drainage 100.0 ml?26.2⁶00.0 ml?,albumin?34.0±3.4?g/l,the rate of leakage 10%,the rate of blood transfusion 7.5%,the rate of infection 12.5%,Clavien–Dindo grade I?15 percent?,Clavien–Dindo grade II?5 percent?,pathological stage pT₁?2.5 percent?,pT₂?52.5 percent?,pT₃?45 percent?]and RSRARP group[estimated blood loss 200 ml?100⁷00 ml?,average daily drainage 80 ml?11.7⁵71.0 ml?,the rate of leakage 5%,the rate of blood transfusion 5%,the rate of infection 5%,Clavien–Dindo grade I?7.5percent?,Clavien–Dindo grade II?5 percent?,pathological stage pT₁?7.5 percent?,pT₂?42.5 percent?,pT₃?50 percent?]had no significant differences?P>0.05?.Continence:Mean time of continence was significantly more in conventional RARP group than in RSRARP group[6 weeks?0¹3 weeks?vs 1 weeks?0¹3weeks?,P<0.05)].Urinary domain of EPIC one month,two months and three months after surgery was significantly more in RSRARP group than in conventional RARP group[91.7 points?55.5¹00.0 points?vs 79.5 points?65.9¹00.0 points?],[100.0points?65.9¹00.0 points?vs 91.3 points?74.3¹00.0 points?],[100.0 points?76.3¹00.0 points?vs 99.0 points?75.8¹00.0 points?],?P<0.05?.Higher urinary domain of EPIC?OR=0.081,95%CI=0.012⁰.551,P=0.014?before operation and lower volume of prostate?OR=10.954,95%CI=2.310¹9.397,P=0.044?were significantly related to better early continence after RSRARP.Sexual potency:There was not significant differences in sexual domain of IIEF-5one month,two months and three months after surgery between RSRARP group and conventional RARP group[0 points?0⁰ points?vs 0 points?0³ points?,0 points?0⁵ points?vs 0 points?0⁴ points?,0 points?0¹0 points?vs 0 points?0⁶ points?,P<0.05].Cancer control:There was not significant differences in tPSA one month,two months and three months after surgery between RSRARP group and conventional RARP group[0.026 ng/ml?0.003².610 ng/ml?vs 0.0345 ng/ml?0.003⁰.680 ng/ml?,0.005 ng/ml?0.003².34 ng/ml?vs 0.005 ng/ml?0.003⁰.624 ng/ml?,0.003 ng/ml?0.003⁰.709 ng/ml?vs 0.003 ng/ml?0.003⁰.421 ng/ml?,P<0.05].Higher tPSA before operation were significantly related to higher rate of biochemical recurrence after RSRAR?OR=6.100,95%CI=1.3131³2.901,P=0.035?.Conclusion:Compared with conventional RARP,RSRARP lead to a shorter operating time;Lower volume of prostate and higher urinary domain of EPIC before operation are significantly related to better early continence;Higher tPSA before operation are significantly related to higher probability of biochemical recurrence;RSRARP is safe and effective for the treatment of localized prostate cancer.