The Posterior First Approach in Robot-assisted Radical Prostatectomy for Prostate Cancer Reduces Positive Surgical Margins on the Bladder Neck Side.

[BACKGROUND/AIM] There is limited data comparing outcomes and quality of life between the conventional robot-assisted radical prostatectomy (RARP) (anterior approach) and the posterior first approach RARP. In the present study, we evaluated the differences between conventional and posterior first approach RARP.

[PATIENTS AND METHODS] This study enrolled consecutive patients who underwent conventional RARP (n=255) and posterior first approach RARP (n=107). Propensity scores were calculated, and patients were matched in a 1:1 ratio based on these scores. The quality of life (QOL), continence, and perioperative outcomes were evaluated in the two groups.

[RESULTS] Using propensity matching, 99 patients were included in each group. The number of patients (75%) whose bladder necks were preserved in the posterior first approach RARP group was significantly higher (<0.001) than that in the conventional RARP group (42%). Positive surgical margin on the side of the bladder neck in the posterior first approach group (1%) was not significantly (=0.03) detected compared to that in the conventional group (8%). There was no significant difference in QOL score at 12 months after RARP or in continence rate within 12 months after RARP.

[CONCLUSION] Compared to the conventional approach, the posterior first approach RARP can preserve the bladder neck and reduce the incidence of positive surgical margins at the bladder neck side.