Retzius‐sparing versus standard robot‐assisted laparoscopic prostatectomy: A two‐year patient‐reported and oncological assessment

Purpose To evaluate the two‐year functional and oncological outcomes of Retzius‐sparing robot‐assisted laparoscopic prostatectomy (rsRALP) and standard approach (sRALP). Methods A total of 200 consecutive patients who underwent either sRALP (n = 100) or rsRALP (n = 100) for clinically localized PCa at a single referral European center between 2015 and 2020 were identified from a prospectively cohort, as part of the Belgian Cancer Registry. Primary outcomes included functional outcomes and quality of life (QoL) using validated patient‐reported outcome measures (PROMs) assessed at 1‐, 3‐, 12‐, and 24‐months post‐surgery. Secondary outcomes comprised oncological outcomes reported as positive surgical margins (PSM) and 5‐year biochemical recurrence (BCR). Kaplan‐Meier analysis with log‐rank test and multivariable Cox regression were used. Results The median follow‐up was 60 months. No significant differences were observed between the surgical approaches in terms of patient and tumor characteristics. Urinary function and QoL were significantly better at each follow‐up period (all p ≤ 0.01) with rsRALP, while sexual function was not significantly different 12 months after surgery. No significant difference in positive surgical margins rate was observed between surgical approaches (31% vs 32%, p = 0.9). Retzius‐sparing RALP was associated with longer PSM lengths (5 mm vs 2.5 mm, p = 0.02), a higher multifocality rate (34% vs. 13%, p