PD54-08: Single-port Extraperitoneal vs Transperitoneal Robotic-Assisted Radical Prostatectomy: A Multi-institutional Matched-pair Comparison of Outcomes

Mahmoud Abou Zeinab*, Ethan Ferguson, Aaron Kaviani, Alp T. Beksac, Cleveland, OH, Marcio Moschovas, Celebration, FL, Luca Morgantini, Chicago, IL, Sij Hemal, Cleveland, OH, Susan Talamini, Chicago, IL, Jean Joseph, Rochester, NY, Moses Kim, Laguna Hills, CA, Simone Crivellaro, Chicago, IL, Vipul Patel, Celebration, FL, Jeffrey Nix, Birmingham, AL, Jihad Kaouk, Cleveland, OH

Introduction: The introduction of the ‘purpose-built’ Single-port (SP) robot successfully expanded the surgical approaches in the management of localized prostate cancer to include the extraperitoneal, in addition to the standard transperitoneal approach. We sought to perform a multi-institutional study to assess the perioperative, and functional outcomes between SP extraperitoneal (ERP) and SP transperitoneal (TRP) radical prostatectomy

Methods: From February 2019 to October 2021, a prospective data collection from six different robotic centers was performed. Data of 412 patients who underwent ERP and 241 patients who underwent TRP were analyzed. All procedures were performed by surgeons with extensive robotic experience.  A 1:1 matched-pair analysis for the National Comprehensive Cancer Network (NCCN) risk was performed. Baseline characteristics, intraoperative, postoperative and functional outcomes were evaluated

Results: Before matching, there was a significantly higher percentage of NCCN high risk in the ERP group compared to the TRP group. After matching, patients in the ERP had a higher rate of previous abdominal surgery (p <.001). The median operative time was 203 vs 169 minutes, median estimated blood loss was 150 vs 87 cc for ERP and TRP, respectively (p <.001). TRP was more likely to include an additional surgical port (SP +1). 37.6% of the ERP group had more extraprostatic extension on pathology compared to 26.8% in the TRP, with no significant difference in the positive surgical margins (25.3% and 26.8%). The median lymph node yield was higher in the ERP group (6 vs 3 nodes, p=.017). ERP patients were more likely to be discharged the same day after the surgery (7 vs 14 hours, p<.001), and had their median Foley catheter stay for 7 days compared to 5 days In the TRP group (p <.007). There was no difference in the perioperative complications or continence rates after the surgery. Median follow-up was 6 months

Conclusions: Both SP ERP and TRP are comparable surgical options for the treatment of localized prostate cancer. ERP is more associated with same-day discharge and higher lymph node yield. TRP has a shorter operative time and less estimated blood loss. The two techniques have similar complications, positive surgical margin, and continence rates

Source of Funding: None