Oncologic and quality-of-life outcomes with wide resection in robot-assisted laparoscopic radical prostatectomy.

OBJECTIVES To assess urinary quality-of-life (QoL) and oncologic outcomes between wide resection (WR) robot-assisted laparoscopic radical prostatectomy (RALP) and non-WR (NWR) RALP in men with intermediate- or high-risk (Cancer of the Prostate Risk Assessment [CAPRA]-9 >2) prostate adenocarcinoma. METHODS Patients undergoing RALP (2004-2013) for intermediate- or high-risk prostate adenocarcinoma were analyzed. Kaplan-Meier methodology with Cox proportional hazards regression evaluated biochemical recurrence-free survival (BCR-FS). Multiple logistic regression was used to determine the relationship between (1) WR with positive surgical margins (+SM) and (2) WR with posterolateral+SM after adjusting for demographics and CAPRA-9 score. University of California, Los Angeles-Prostate Cancer Index and Extended Prostate Cancer Index Composite questionnaires assessed urinary QoL. Multiple mixed-effects linear regression adjusting for demographics and CAPRA-9 evaluated differences in QoL between WR and NWR. RESULTS A total of 483 RALP cases met inclusion criteria-129 (26.7%) underwent WR and 354 (73.3%) underwent NWR-RALP. There were no demographic differences between groups. Burden of disease was greater in patients undergoing WR (P<0.001). There was no difference in+SM rates between WR and NWR (P = 0.505). Adjusting for demographics and CAPRA-9 score, WR patients had a clinically relevant 27% decrease in posterolateral+SM (odds ratio = 0.73; 95% CI: 0.38-1.41; P = 0.351). WR was not associated with worse BCR-FS (hazard ratio = 1.24; 95% CI: 0.83-1.86, P = 0.30). Adjusting for pathology, University of California, Los Angeles and Extended Prostate Cancer Index Composite urinary domain scores were similar between WR and NWR groups. CONCLUSION Despite WR patients having worse clinical disease, WR-RALP can be performed with minimal detriment to BCR-FS and urinary QoL. The greater incidence of occult metastasis in higher risk patients may make surgical technique a nonsignificant factor. Nevertheless, WR remains a reasonable option for complete surgical excision.