Robotic-assisted radical prostatectomy following colo-rectal surgery: a user's guide

Area of Science:

• Urology
• Surgical Oncology
• Colorectal Surgery

Background:

• Previous pelvic surgery, including colorectal procedures, can complicate subsequent radical prostatectomy.
• Assessing the feasibility and outcomes of robotic-assisted radical prostatectomy (RARP) in patients with prior colorectal surgery is crucial for surgical planning.

Purpose of the Study:

• To evaluate the feasibility and operative outcomes of RARP in patients who have previously undergone colorectal surgery.
• To identify risk factors for conversion to open surgery during RARP after colorectal procedures.

Main Methods:

• A prospective database of RARP patients was reviewed, focusing on those with a history of colorectal surgery.
• Data collected included details of previous colorectal surgery, prostatectomy operative times, conversion rates, and postoperative complications.

Main Results:

• Of 658 RARPs, 14 were performed after colorectal surgery. The robotic approach was successful in 11 cases with uncomplicated prior surgery.
• Open conversion occurred in 3 cases, associated with multiple/complicated abdominal surgeries, prior open conversion, or prolonged hospital stay (>10 days).
• Postoperative complications were infrequent, including anemization, persistent drain output, and urinary tract infection.

Conclusions:

• RARP is feasible and offers successful outcomes in patients with a history of uncomplicated colorectal surgery.
• For patients with multiple or complicated prior abdominal surgeries, a direct retropubic approach may be considered due to the risk of intestinal injury during conversion.
• Preoperative urologic evaluation should be thorough for patients undergoing elective colorectal surgery, considering potential future prostate surgery.