Scholarlink

Objective <p>To compare the efficacy and safety of robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) in patients with High risk prostate cancer using propensity score matching (PSM).</p> Methods <p>A total of 450 eligible patients were enrolled, including 228 in the RARP group and 222 in the LRP group. PSM was used to balance baseline confounders. Key outcomes included surgical parameters, perioperative recovery, intraoperative complications, 30-day readmission, biochemical recurrence (BCR)-free survival, and postoperative functional recovery (urinary continence and erectile function).</p> Results <p>RARP had less intraoperative blood loss (mean difference − 75 mL, 95% CI -92 to -58), shorter hospital stay (mean difference − 1.2 days, 95% CI -1.6 to -0.8), earlier ambulation/feeding, and higher 3-year BCR-free survival (71.0%, 95% CI 64.7%–76.5% vs. 52.8%, 95% CI 46.1%–59.3%; HR 0.62, 95% CI 0.46–0.84) than LRP. At 12 months, RARP showed better urinary continence (98.0%, 95% CI 95.0%–99.3% vs. 92.0%, 95% CI 87.3%–95.2%; RR 1.07, 95% CI 1.01–1.13) and erectile function recovery. Importantly, erectile function recovery was calculated only among patients who underwent nerve-sparing procedures and had normal preoperative erectile function (IIEF-5 ≥ 22). Among High risk patients, selective nerve-sparing was performed in 41.9% (95% CI 35.3%–48.8%) of RARP cases and 35.6% (95% CI 29.2%–42.5%) of LRP cases, typically in younger patients (&lt; 65 years) with unilateral High risk features and no evidence of extracapsular extension on preoperative MRI. Among this select subgroup, 72.3% (95% CI 63.2%–80.0%) of RARP patients and 58.1% (95% CI 48.7%–67.0%) of LRP patients achieved erectile function recovery (IIEF-5 ≥ 17) at 12 months (RR 1.24, 95% CI 1.01–1.53), consistent with contemporary series reporting nerve-sparing outcomes in carefully selected High risk patients. The two groups had comparable intraoperative complication and 30-day readmission rates, with differing dominant readmission causes. A nomogram predicting 5-year BCR risk showed good performance (C-index = 0.78).</p> Conclusion <p>In this propensity score-matched analysis of High risk prostate cancer patients, RARP was associated with faster perioperative recovery, better 12-month functional outcomes, and improved unadjusted BCR-free survival compared with LRP, with comparable safety profiles. However, surgical approach was not an independent predictor of BCR in multivariate analysis, suggesting the oncologic benefit is mediated through improved surgical quality indicators. RARP represents an excellent surgical option for High risk prostate cancer, offering advantages in recovery and functional preservation without compromising oncologic safety when performed by experienced surgeons.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Perioperative and oncologic outcomes of robot-assisted and laparoscopic radical prostatectomy in high risk prostate cancer with propensity score matching

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年8月4日

查看全文
  • Junchao Bai,
  • Keliang Chen,
  • Zheping Jiang,
  • Junchao Bai

摘要

Objective

To compare the efficacy and safety of robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) in patients with High risk prostate cancer using propensity score matching (PSM).

Methods

A total of 450 eligible patients were enrolled, including 228 in the RARP group and 222 in the LRP group. PSM was used to balance baseline confounders. Key outcomes included surgical parameters, perioperative recovery, intraoperative complications, 30-day readmission, biochemical recurrence (BCR)-free survival, and postoperative functional recovery (urinary continence and erectile function).

Results

RARP had less intraoperative blood loss (mean difference − 75 mL, 95% CI -92 to -58), shorter hospital stay (mean difference − 1.2 days, 95% CI -1.6 to -0.8), earlier ambulation/feeding, and higher 3-year BCR-free survival (71.0%, 95% CI 64.7%–76.5% vs. 52.8%, 95% CI 46.1%–59.3%; HR 0.62, 95% CI 0.46–0.84) than LRP. At 12 months, RARP showed better urinary continence (98.0%, 95% CI 95.0%–99.3% vs. 92.0%, 95% CI 87.3%–95.2%; RR 1.07, 95% CI 1.01–1.13) and erectile function recovery. Importantly, erectile function recovery was calculated only among patients who underwent nerve-sparing procedures and had normal preoperative erectile function (IIEF-5 ≥ 22). Among High risk patients, selective nerve-sparing was performed in 41.9% (95% CI 35.3%–48.8%) of RARP cases and 35.6% (95% CI 29.2%–42.5%) of LRP cases, typically in younger patients (< 65 years) with unilateral High risk features and no evidence of extracapsular extension on preoperative MRI. Among this select subgroup, 72.3% (95% CI 63.2%–80.0%) of RARP patients and 58.1% (95% CI 48.7%–67.0%) of LRP patients achieved erectile function recovery (IIEF-5 ≥ 17) at 12 months (RR 1.24, 95% CI 1.01–1.53), consistent with contemporary series reporting nerve-sparing outcomes in carefully selected High risk patients. The two groups had comparable intraoperative complication and 30-day readmission rates, with differing dominant readmission causes. A nomogram predicting 5-year BCR risk showed good performance (C-index = 0.78).

Conclusion

In this propensity score-matched analysis of High risk prostate cancer patients, RARP was associated with faster perioperative recovery, better 12-month functional outcomes, and improved unadjusted BCR-free survival compared with LRP, with comparable safety profiles. However, surgical approach was not an independent predictor of BCR in multivariate analysis, suggesting the oncologic benefit is mediated through improved surgical quality indicators. RARP represents an excellent surgical option for High risk prostate cancer, offering advantages in recovery and functional preservation without compromising oncologic safety when performed by experienced surgeons.