PD27-06: Increased Awareness of Surgical Outcomes Improves Long-term Functional Outcomes after Robot-assisted Radical Prostatectomy. A Prospective Assessment Following Implementation of Prospective Data Collection

Giuseppe Cirulli*, Milan, Italy, Giuseppe Rosiello, Elio Mazzone, Milano, Italy, Nicola Fossati, Lugano, Switzerland, Francesco Barletta, Simone Scuderi, Daniele Robesti, Milano, Italy, Giorgio Gandaglia, Milan, Italy, Lorenzo Toneatto, Gianmarco Colandrea, Riccardo Leni, Lucia D’Ambrosio, Antony Pellegrino, Leonardo Quarta, Milano, Italy, Andrea Gallina, Lugano, Switzerland, Vito Cucchiara, Milan, Italy, Alberto Martini, Milano, Italy, Sabrina Comana, Milan, Italy, Armando Stabile, Milano, Italy, Enrico Camisassa, Milan, Italy, Federico Dehò, Varese, Italy, Francesco Montorsi, Alberto Briganti, Milano, Italy

Introduction: A detailed knowledge of postoperative outcomes following implementation of prospective data collection might lead to change in patient management and ultimately reduce the risk of adverse outcomes in patients undergoing robot-assisted radical prostatectomy (RARP). We tested whether prospective implementation of patient outcomes assessment followed by an audit and feedback approach and subsequent change in surgical technique was associated with improved functional outcomes after RARP.

Methods: Overall, 1,326 consecutive patients who underwent RARP ± extended pelvic lymph node dissection (ePLND) for PCa from November 2016 to July 2021 at a tertiary center were identified. Post-operative complications were prospectively collected based on the quality criteria for accurate and comprehensive reporting of surgical outcomes recommended by the European Association of Urological (EAU) Guidelines. In January 2018 an audit and feedback process was implemented, where the most common complications (anastomotic leak) were identified. Following this process, a change in the anastomotic technique was implemented and prospectively applied to decrease the rate of anastomotic leak. Urinary continence (UC) recovery was defined as use of one safety pad or no pads. Early continence (EC) recovery was defined as UC recovery at 3-month from surgery. Erectile function (EF) was defined as an International Index of Erectile Function Questionnaire (IIEF)>17. Multivariable competing-risk regression analyses evaluated the impact of surgical changes on functional outcomes, namely UC and EF recovery after surgery, after accounting for age, BMI, pathological stage, ASA score and ePLND.

Results: Overall, 767 (58%, Group 2) patients were treated after the implementation of surgical changes. Median age at surgery (65 vs. 64 years), PSA (6.6 vs. 6.8 ng/mL) and BMI (25 vs. 26 kg/m2) did not differ between the two groups (p>0.05). Overall and Clavien-Dindo =2 complication rates were lower in Group 2 vs. Group 1 (30 vs. 42% and 6.1 vs. 23%; all p=0.01). Similarly, rate of anastomotic leaks was significantly lower in Group 2 compared to Group 1 (3.1 vs. 9.6%; p<0.01). 12-months cumulative incidence of UC and EF recovery were 88% (95%CI 75-91%) vs. 80% (95%CI 76-83%) and 25% (95%CI 20-30%) vs. 20% (95%CI 16-25%) in Group 2 vs. Group 1 (p < 0.001), respectively. EC recovery rates were higher in Group 2 vs. Group 1, respectively (53 vs. 42%; p<0.001). At multivariable analyses, being treated after the implementation of the new surgical technique was associated with increased UC (HR: 1.15; p=0.03) and EF recovery (HR: 1.28; p=0.03).

Conclusions: Increased awareness of perioperative outcomes prompted to the implementation of a novel surgical technique aimed at decreasing the risk of adverse outcomes after RARP. This process translated in better functional outcomes at follow-up. Prospective assessment of surgical complications is key for implementing modified approaches and also increasing functional outcomes after surgery.

Source of Funding: none