Dados do Trabalho

Título

FUNCTIONAL AND ONCOLOGICAL OUTCOMES OF VERY LARGE PROSTATE SIZES POST ROBOTIC RADICAL PROSTATECTOMY

Resumo

Background
Robotic-assisted radical prostatectomy (RARP) is widely used as the main surgical approach to treat prostate cancer in the USA. Prostate size is always depicted as a factor affecting the outcomes of RARP as shown by many studies, but these studies are limited to a small number of tested patients.
Objective:
To evaluate the functional, and oncologic outcomes of RARP in extremely large prostate sizes.
Design, settings, and participants
375 RARP patients were divided into 2 groups according to prostate size. Group 1 (>150g) and Group 2 (<50g). Perioperative variables matched with propensity score matching 1:3 and postoperative variables were analyzed for significant differences in outcomes between the two groups. Variables analyzed included estimated blood loss (EBL), operative time, catheter time, hospitalization time, postoperative complications, pathological staging, positive surgical margins (PSM) rates, biochemical recurrence (BCR), potency, and continence rates.
Results and limitations
The two groups exhibited similar preoperative characteristics. Patients with larger prostates (Group 1) were more likely to have higher blood loss (EBL), higher console time, however there was no significant difference in the overall postoperative complications (Clavien-Dindo). These patients also had fewer lymph node dissection rates compared to those with smaller prostates (51.28% and 71.45%) for Group 1and Group 2, respectively. Pathological outcomes were also statistically different, patients with larger prostates had more pT2 disease (69.70% vs 47.83%), lower rates of PSM (12.12% vs 22.46%). Finally, we observed no significant difference in the functional outcomes in the 2 groups, rates of urinary continence (70.9% vs 72.5%, P=0.5) and recovery of sexual function (70.0% vs 84.1%, P=0.7).
Conclusion
The results demonstrate that prostate size reflects multiple outcomes, such as nerve-sparing, lymph node dissection, potency, oncological and pathological outcomes. We believe this data is valuable when counseling patients regarding possible outcomes before the procedure.
Key Words: Prostate Size; Radical Prostatectomy; Robotic assisted