Extraperitoneal versus transperitoneal robot-assisted laparoscopic total prostatectomy: Comparison after propensity...

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Robot-assisted laparoscopic radical prostatectomy (RALRP) is standard for localized prostate cancer.
• Transperitoneal (TP) and extraperitoneal (EP) are common surgical access routes.
• Real-world data comparing TP and EP approaches outside high-volume centers are limited.

Purpose of the Study:

• To compare morbidity and oncological outcomes of TP versus EP approaches in RALRP.
• To evaluate outcomes in a standard clinical setting, not a high-specialty center.

Main Methods:

• Retrospective monocentric cohort study (210 patients, 2016-2024).
• Propensity score matching created two groups of 52 patients each (TP vs. EP).
• Outcomes included Clavien-Dindo complications, surgical margins, and biochemical recurrence.

Main Results:

• No significant difference in overall complication rates (27% TP vs. 29% EP).
• Comparable rates of positive surgical margins (33% TP vs. 23% EP).
• Similar biochemical recurrence rates (17% TP vs. 12% EP).

Conclusions:

• EP and TP approaches demonstrated comparable perioperative morbidity and oncological outcomes in an intermediate-volume center.
• The study's limited statistical power prevents definitive conclusions on oncological equivalence.
• Further investigation is warranted to establish equivalence between TP and EP approaches in RALRP.