IMPACT OF MINIMALLY INVASIVE APPROACH ON THE PROBABILITY OF EARLY COMPLETE FUNCTIONAL RECOVERY AFTER BILATERAL NERVE SPARING RADICAL PROSTATECTOMY

INTRODUCTION & OBJECTIVES: Controversy exists on functional recovery associated with robotic-assisted radical prostatectomy (RARP)as compared to the open approach (RRP). While long-term functional outcomes seem to be comparable, RARP seems to be associatedwith earlier functional recovery. However, no study tested the benefit of RARP in terms of early post-operative full functional recovery. Weinvestigated whether surgical approach affects both early post-operative urinary continence (UC) and erectile function (EF) recovery.MATERIAL & METHODS: The study included 1798 patients with prostate cancer treated with bilateral nerve-sparing radical prostatectomy,performed by a single surgeon between 2006 and 2013 at a single tertiary referral centre. Pre and post-operative EF was assessed by theInternational Index of Erectile Function (IIEF-EF). Urinary function was evaluated with the International Consultation on Incontinencequestionnaire (ICIQ). Functional outcomes were recorded 2 months after surgery and then every 4 months during the first year and every 6months thereafter. EF recovery was defined as post-operative IIEF-EF>21. UC recovery was defined as ICIQ score ≤6. Chi-square testevaluated the rates of UC, EF, and both UC and EF recovery (Bifecta) at 2 months according to the surgical approach. The role of surgicalapproach on UC, EF, and Bifecta recovery at 2 months was evaluated at univariable and multivariable logistic regression analyses afteraccounting for age, BMI, pre-operative EF, PSA, pathological stage and grade. Finally, univariable and multivariable Cox regressionanalyses also assessed the role of surgical approach on functional outcomes over time.RESULTS: At a mean follow-up of 41.8 months, 75.1 and 54.9 % of patients recovered UC and EF, and 616 patients recovered both(42.5%). 2 months after surgery, 36.5, 13.2 and 7.6% of patients recovered UC, EF and both conditions, respectively. UC, EF and Bifectarecovery at 2 months after surgery in men treated with RARP were significantly higher than patients treated with RRP (51.6 vs.27.3%, 21.6vs.8.6%, 14.5 vs. 3.4%, respectively, all p<0.001). At logistic regression analyses, patient age, pre-operative EF and surgical techniquewere significantly associated with the rate of UC recovery at 2 months after surgery (OR =0.96, p<0.001, OR=1.66, p=0.03 and OR= 4.13,p<0.001, respectively). Patient age, pre-operative EF and surgical technique were the only predictors of EF recovery at 2 months aftersurgery (OR=0.95, p<0.001, OR=3.01, p=0.008 and OR=3.23, p<0.001, respectively). When Bifecta at 2 months was considered asendpoint, patient age, pre-operative EF and surgical technique remained the only significant predictors of an early optimal functionaloutcome (OR=0.95, p=0.003, OR=7.3, p=0.007 and OR=5.7, p<0.001, respectively). At Cox regression analyses, surgical approachremained also a major independent predictor of optimal functional outcomes over time (HR=2.3, 1.6 and 1.9 when predicting UC, EF andBifecta recovery, respectively, all p<0.01).CONCLUSIONS: Robotic-assisted surgery provides earlier functional recovery than the open approach. Patients treated with RARP hadroughly 4-fold, 3-fold and 6-fold higher probability of UC, EF, and Bifecta recovery at after 2 months. Moreover, the positive impact of aminimally-invasive technique on functional outcomes remained over time.