A Comparison of Extraperitoneal and Intraperitoneal Approaches for Robotic Prostatectomy

Objectives. This study compared oncologic and health-related quality-of-life outcomes among patients undergoing intraperitoneal or extraperitoneal robotic prostatectomy. Methods. Of 215 patients undergoing robotic prostatectomy, the approach was intraperitoneal in 48 and extraperitoneal in 167. Cancer control was evaluated using margin status. Recovery after surgery and functional health was assessed using the Convalescence and Recovery Evaluation and Expanded Prostate Cancer Index Composite questionnaires, respectively. Results. Positive surgical margin rates were similar between approaches (14% extraperitoneal, 10% intraperitoneal; P = .63). Functional outcomes were slightly improved for those with the extraperitoneal approach (ie, higher urinary irritation/obstruction scores at 3 months). The extraperitoneal group demonstrated higher activity (91.8 vs 83.3, P = .03) and cognitive scores (94.9 vs 91.7, P = .04) at 6 weeks as well as higher gastrointestinal scores at 2 weeks (94.2 vs 90.8, P = .05). Conclusions. These data support efforts to broaden the adoption of the extraperitoneal approach for robotic prostatectomy.