Background/Objectives: Robot-assisted radical prostatectomy (RARP) has emerged as the predominant surgical approach globally, and various techniques have been proposed to improve functional outcomes. Despite these advances, however, functional impairment associated with surgery remains a major concern that affects patients’ quality of life. Retzius-sparing RARP (RS-RARP) has been proposed as a surgical technique to preserve the Retzius space, and increasing evidence has demonstrated its effectiveness. However, the effect of RS-RARP on other functions remains unknown. Although some reports show the positive effect of Retzius-sparing RARP (RS-RARP) on urinary incontinence, the effects on other functions remain unknown. Methods: The present study retrospectively analyzed 132 patients who underwent RARP at Kitasato University Hospital between January 2020 and July 2021 (49 and 83 patients in the RS-RARP and conventional RARP groups, respectively). We compared the functional outcomes of RS-RARP and conventional RARP (C-RARP) using the Expanded Prostate Cancer Index Composite (EPIC). In addition, sexual function was compared among patients who underwent nerve-sparing procedures. Results: Our findings revealed that, even at 12 months postoperatively, RS-RARP demonstrated significant preservation of urinary continence (p< 0.01) and sexual function compared to C-RARP (p= 0.03). No significant differences were observed in the bowel or hormonal domains. Even in patients who underwent nerve-sparing surgery, the EPIC score 12 months postoperatively was significantly higher with RS-RARP than with C-RARP (p< 0.01). RS-RARP tended to result in positive surgical margins more often than C-RARP (RS-RARP: 44.9%, C-RARP: 28.9%,p= 0.06), without affecting the rate of biochemical recurrence (RS-RARP: 14.2%, C-RARP: 15.7%,p= 0.81). Conclusions: Our results suggest a potential advantage of RS-RARP in preserving both urinary and sexual function.
背景/目的：机器人辅助根治性前列腺切除术（RARP）已成为全球主流手术方式，多种技术被提出以改善功能预后。然而，尽管技术不断进步，手术相关的功能障碍仍是影响患者生活质量的主要问题。保留Retzius间隙的RARP（RS-RARP）作为一种保留Retzius空间的手术技术被提出，越来越多的证据证明了其有效性。但RS-RARP对其他功能的影响尚不明确。尽管有报告显示保留Retzius间隙的RARP（RS-RARP）对尿失禁有积极影响，但其对其他功能的作用仍未可知。方法：本研究回顾性分析了2020年1月至2021年7月期间在北里大学医院接受RARP的132例患者（RS-RARP组49例，传统RARP组83例）。我们使用扩展前列腺癌综合指数（EPIC）比较了RS-RARP与传统RARP（C-RARP）的功能预后。此外，在接受保留神经手术的患者中比较了性功能。结果：我们的研究结果显示，即使在术后12个月，RS-RARP在尿控（p<0.01）和性功能（p=0.03）方面均显著优于C-RARP。在肠道或激素领域未观察到显著差异。即使在接受保留神经手术的患者中，术后12个月的EPIC评分RS-RARP也显著高于C-RARP（p<0.01）。RS-RARP的手术切缘阳性率有高于C-RARP的趋势（RS-RARP：44.9%，C-RARP：28.9%，p=0.06），但未影响生化复发率（RS-RARP：14.2%，C-RARP：15.7%，p=0.81）。结论：我们的结果表明RS-RARP在保留泌尿功能和性功能方面具有潜在优势。
肿瘤(癌症)患者之家