Extraperitoneal Single Port vs Transperitoneal Multiport Robot assisted radical prostatectomy in frail patients: A propensity score matched comparative analysis.

Purpose: The rise of frail patients in the worldwide population poses a challenge in the prostate cancer surgical care. In this light, we aimed to compare perioperative and early surgical outcomes of Extraperitoneal Single Port (SP)- vs Transperitoneal Multiport (MP) - Robot Assisted Radical Prostatectomy (RALP) in different frailty settings.
Materials and Methods: Clinical and surgical data of all consecutive patients treated with RALP between March 2014 and October 2023 were gathered. Propensity score matching was performed to adjust for potential baseline pre-operative confounders. The 5-miFI score was calculated for each patient and then five risk categories were identified (5-mFI score = 0, 1,2,3 and ≥ 4).
Results: A total of 549 patients were assessed in the unmatched analysis. After the propensity score, 126 patients for each treatment group were matched. When stratified in different frailty-groups, 30-days postoperative complications occurred significantly more frequently in case of 5-mFI score=3 and >4 (p = 0.001). Moreover, higher rate of both overall (52 vs 23 %, p = 0.01) and major (19.6 vs 8.2 %, p = 0.02) postoperative complications was found in these patients in case of transperitoneal MP RARP as compared to the extraperitoneal SP procedures. Exploring predictors of postoperative early complications in patients with 5-mFI score = 3 and 4, extraperitoneal SP robotic approach showed a significant protective role on both overall (OR 0.21, p = 0.001) and major (OR 0.33, p = 0.001) complications occurrence.
Conclusions: In a matched cohort of patients treated with Robot Assisted Radical Prostatectomy, extraperitoneal Single Port approach significantly reduced the overall and major early complications rate in frail patients.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)