Comparative Analysis Of The Efficacy Of Robotic-assisted Laparoscopic Radical Prostate Cancer Resection With Preservation Of The Retzius Space Via The Anterior Approach Versus The Transvesical Approach

Objective:To compare the perioperative outcomes,oncological control and functional preservation of patients with limited prostate cancer with the transvesical approach preserving the Retzius space for robotic-assisted laparoscopic radical prostatectomy(Tv-RARP)and the modified anterior approach preserving the Retzius space for robotic-assisted laparoscopic radical prostatectomy(Ma-RARP).Methods:Retrospective analysis of 60 patients who underwent RARP in the Department of Urology at the First Affiliated Hospital of Nanchang University from September 2019 to October 2022,all procedures were performed by the same experienced urologist.They were divided into Tv-RARP group(27 cases)and Ma-RARP group(33 cases)according to the procedure.The patients’ preoperative baseline data,perioperative conditions and postoperative pathology were counted,and the patients were followed up for postoperative urinary control.Oncological outcome was assessed by post-operative pathology as well as by follow-up post-operative t PSA.The median follow-up period was 12 months.Results:There were no significant differences in age,body mass index,preoperative prostate specific antigen value,prostate volume,Gleason score,or clinical stage of prostate cancer between the Tv-RARP and Ma-RARP groups(P>0.05).About perioperative data Ma-RARP group and Tv-RARP group estimated intraoperative blood amount [150(100-175)ml VS 200(100-200)ml,P=0.403],intraoperative blood transfusion(3.0%VS7.4%,P=0.583),postoperative hospital stay(8.18±2.31 d VS8.15±2.35 d,P=0.701),catheter indinduration time [7.0(7.0-7.0)d VS 7.0(7.0-7.0)d,P=0.536],surgical complications(9.1% VS 7.4%,P=1.000)was not statistically significant.However,the operative time of Ma-RARP group and Tv-RARP group was significantly different(186.36±34.06 min VS 227.00±62.13 min,P=0.021),and the operative time of Ma-RARP group was shorter.In terms of postoperative pathology,the ratio of Gleason score ≤6,7,≥8 in Ma-RARP group and Tv-RARP group was(15.2%,72.7%,12.1% VS 14.8%,70.4%,14.8%,P=0.954).T2 and T3 pathological stages accounted for(90.9%,9.1% VS 92.6%,7.4%,P=1.000),and the positive rate of surgical margin was(24.2% VS 25.9%,P=0.881).The above differences were not statistically significant.In terms of urine control function and biochemical recurrence,the rate of immediate urine control(69.7% VS 74.1%,P=0.708),the rate of urine control at 1 week after surgery(81.8% VS 88.9%,P=0.495),the rate of urine control at1 month after surgery(97.0% VS 100%,P=1.000),urine control rate 3 months after surgery(100% VS 100%);t PSA at 1 week after surgery [2.10(1.60-2.65)ng/ml VS2.25(1.89-2.54)ng/ml,P=0.404],t PSA 3 months after surgery [0.06(0.02-0.10)ng/ml VS 0.06(0.01-0.08)ng/ml,P=0.606],t PSA 6 months after surgery [0.01(0.01-0.02)ng/ml VS 0.01(0.01-0.02)ng/ml,P=0.876];There was no significant difference in biochemical recurrence rate(3.0% VS 3.7%,P=1.000)6 months after surgery.Conclusion:The primary goal of tumour control is achieved with both the transvesical approach and the modified anterior approach,and postoperatively patients have demonstrated good early urinary control recovery with low surgical complications.However,the Tv-RARP technique has a long learning curve and the prostate volume selected for early transcystal approach should not be large(<50 ml);Ma-RARP has a short learning curve for experienced surgeons and the procedure is more familiar.Preoperative development of the optimal surgical approach based on the location of the cancer combined with clinical staging of the tumour,grading grouping of the puncture pathology and prostate volume,and achieving optimal anatomical separation intraoperatively,are key to achieving tumour control and rapid functional recovery postoperatively.