Retzius-sparing versus standard robot-assisted laparoscopic prostatectomy: A two-year patient-reported and oncological assessment

Purpose: To evaluate the two-year functional and oncological outcomes of Retzius-sparing robot-assisted laparoscopic prostatectomy (rsRALP) and standard approach (sRALP). Methods: A total of 200 consecutive patients who underwent either sRALP (n = 100) or rsRALP (n = 100) for clinically localized PCa at a single referral European center between 2015 and 2020 were identified from a prospectively cohort, as part of the Belgian Cancer Registry. Primary outcomes included functional outcomes and quality of life (QoL) using validated patient-reported outcome measures (PROMs) assessed at 1-, 3-, 12-, and 24-months post-surgery. Secondary outcomes comprised oncological outcomes reported as positive surgical margins (PSM) and 5-year biochemical recurrence (BCR). Kaplan-Meier analysis with log-rank test and multivariable Cox regression were used. Results: The median follow-up was 60 months. No significant differences were observed between the surgical approaches in terms of patient and tumor characteristics. Urinary function and QoL were significantly better at each follow-up period (all p <= 0.01) with rsRALP, while sexual function was not significantly different 12 months after surgery. No significant difference in positive surgical margins rate was observed between surgical approaches (31% vs 32%, p = 0.9). Retzius-sparing RALP was associated with longer PSM lengths (5 mm vs 2.5 mm, p = 0.02), a higher multifocality rate (34% vs. 13%, p < 0.001), more occurrences in organ-confined disease (59% vs. 39%, p < 0.001) and at anterior locations (37% vs. 16%, p = 0.05). Five-year BCR-free survival was not significantly different, and surgical approach was not a predictor of BCR. Conclusions: The rsRALP approach significantly improves both early and short-term urinary function and QoL compared to sRALP. Despite being associated with worse PSM characteristics, no significant decrease in BCR-free survival was observed with rsRALP.