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

Robot-assisted laparoscopic radical prostatectomy (RALRP) has become the standard surgical approach for the treatment for localized prostate cancer. Two main surgical site access are commonly used: transperitoneal (TP) and extraperitoneal (EP). While high-volume specialized centers have demonstrated comparable outcomes between these two techniques, data from real-world clinical practices remain limited. The aim of our study was to compare the morbidity and oncological outcomes of RALRP via TP and EP in a standard clinical setting, outside of high-specialty centers.

We conducted a retrospective monocentric cohort study including 210 patients who underwent surgery between 2016 and 2024. After propensity score matching, 52 patients who underwent surgery via the TP approach were compared to 52 patients who underwent surgery via the EP approach, with a single surgeon performing each technique. The outcomes assessed included complications according to the Clavien-Dindo classification, surgical margins, and biochemical recurrence.

The two groups were comparable in terms of preoperative characteristics. The overall complication rate was not significantly different (27% vs 29%, P=0.83). The rates of positive surgical margins (33% TP vs 23% EP, P=0.64) and biochemical recurrence (17% vs 12%, P=0.40) were also comparable.

After propensity score matching, the EP and TP approaches were associated with comparable perioperative morbidity and oncological outcomes in an intermediate-volume centre. Although no statistically significant difference was detected between the two techniques, the limited statistical power of our study does not allow these findings to be considered as formal evidence of oncological equivalence.

Grade C.