Robotic Radical Prostatectomy for Prostate Cancer in Renal Transplant Recipients: Results from a Multicenter Series

TY - JOUR

T1 - Robotic Radical Prostatectomy for Prostate Cancer in Renal Transplant Recipients: Results from a Multicenter Series

AU - Marra, Giancarlo

AU - Agnello, Marco

AU - Giordano, Andrea

AU - Soria, Francesco

AU - Oderda, Marco

AU - Dariane, Charles

AU - Timsit, Marc-Olivier

AU - Branchereau, Julien

AU - Hedli, Oussama

AU - Mesnard, Benoit

AU - Tilki, Derya

AU - Olsburgh, Jonathon

AU - Kulkarni, Meghana

AU - Kasivisvanathan, Veeru

AU - Breda, Alberto

AU - Biancone, Luigi

AU - Gontero, Paolo

AU - Collaborators

N1 - Copyright © 2022 European Association of Urology. Published by Elsevier B.V. All rights reserved.

PY - 2022/12

Y1 - 2022/12

N2 - BACKGROUND: Despite an expected increase in prostate cancer (PCa) incidence in the renal transplant recipient (RTR) population in the near future, robot-assisted radical prostatectomy (RARP) in these patients has been poorly detailed. It is not well understood whether results are comparable to RARP in the non-RTR setting.OBJECTIVE: To describe the surgical technique for RARP in RTR and report results from our multi-institutional experience.DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective review of the experience of four referral centers.SURGICAL PROCEDURE: Transperitoneal RARP with pelvic lymph node dissection in selected patients.MEASUREMENTS: We measured patient, PCa, and graft baseline features; intraoperative and postoperative parameters; complications, (Clavien classification); and oncological and functional outcomes.RESULTS AND LIMITATIONS: We included 41 men. The median age, American Society of Anesthesiologists score, preoperative renal function, and prostate-specific antigen were 60 yr (interquartile range [IQR] 57-64), 2 points (IQR 2-3), 45 ml/min (IQR 30-62), and 6.5 ng/ml (IQR 5.2-10.2), respectively. Four men (9.8%) had a biopsy Gleason score >7. The majority of the patients (70.7%) did not undergo lymphadenectomy. The median operating time, hospital stay, and catheterization time were 201 min (IQR 170-250), 4 d (IQR 2-6), and 10 d (IQR 7-13), respectively. At final pathology, 11 men had extraprostatic extension and seven had positive surgical margins. At median follow-up of 42 mo (IQR 24-65), four men had biochemical recurrence, including one case of local PCa persistence and one local recurrence. No metastases were recorded while two patients died from non-PCa-related causes. Continence was preserved in 86.1% (p not applicable) and erections in 64.7% (p = 0.0633) of those who were continent/potent before the procedure. Renal function remained unchanged (p = 0.08). No intraoperative complications and one major (Clavien 3a) complication were recorded.CONCLUSIONS: RARP in RTR is safe and feasible. Overall, operative, oncological, and functional outcomes are comparable to those described for the non-RTR setting, with graft injury remaining undescribed. Further research is needed to confirm our findings.PATIENT SUMMARY: Robot-assisted removal of the prostate is safe and feasible in patients who have a kidney transplant. Cancer control, urinary and sexual function results, and surgical complications seem to be similar to those for patients without a transplant, but further research is needed.

AB - BACKGROUND: Despite an expected increase in prostate cancer (PCa) incidence in the renal transplant recipient (RTR) population in the near future, robot-assisted radical prostatectomy (RARP) in these patients has been poorly detailed. It is not well understood whether results are comparable to RARP in the non-RTR setting.OBJECTIVE: To describe the surgical technique for RARP in RTR and report results from our multi-institutional experience.DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective review of the experience of four referral centers.SURGICAL PROCEDURE: Transperitoneal RARP with pelvic lymph node dissection in selected patients.MEASUREMENTS: We measured patient, PCa, and graft baseline features; intraoperative and postoperative parameters; complications, (Clavien classification); and oncological and functional outcomes.RESULTS AND LIMITATIONS: We included 41 men. The median age, American Society of Anesthesiologists score, preoperative renal function, and prostate-specific antigen were 60 yr (interquartile range [IQR] 57-64), 2 points (IQR 2-3), 45 ml/min (IQR 30-62), and 6.5 ng/ml (IQR 5.2-10.2), respectively. Four men (9.8%) had a biopsy Gleason score >7. The majority of the patients (70.7%) did not undergo lymphadenectomy. The median operating time, hospital stay, and catheterization time were 201 min (IQR 170-250), 4 d (IQR 2-6), and 10 d (IQR 7-13), respectively. At final pathology, 11 men had extraprostatic extension and seven had positive surgical margins. At median follow-up of 42 mo (IQR 24-65), four men had biochemical recurrence, including one case of local PCa persistence and one local recurrence. No metastases were recorded while two patients died from non-PCa-related causes. Continence was preserved in 86.1% (p not applicable) and erections in 64.7% (p = 0.0633) of those who were continent/potent before the procedure. Renal function remained unchanged (p = 0.08). No intraoperative complications and one major (Clavien 3a) complication were recorded.CONCLUSIONS: RARP in RTR is safe and feasible. Overall, operative, oncological, and functional outcomes are comparable to those described for the non-RTR setting, with graft injury remaining undescribed. Further research is needed to confirm our findings.PATIENT SUMMARY: Robot-assisted removal of the prostate is safe and feasible in patients who have a kidney transplant. Cancer control, urinary and sexual function results, and surgical complications seem to be similar to those for patients without a transplant, but further research is needed.

KW - Humans

KW - Male

KW - Prostate/pathology

KW - Robotic Surgical Procedures/adverse effects

KW - Robotics

KW - Kidney Transplantation/adverse effects

KW - Prostatectomy/adverse effects

KW - Prostatic Neoplasms/surgery

KW - Kidney/physiology

KW - Treatment Outcome

U2 - 10.1016/j.eururo.2022.05.024

DO - 10.1016/j.eururo.2022.05.024

M3 - SCORING: Journal article

C2 - 35750583

VL - 82

SP - 639

EP - 645

JO - EUR UROL

JF - EUR UROL

SN - 0302-2838

IS - 6

ER -