title: The trifecta outcome in 300 consecutive cases of robotic-assisted laparoscopic radical prostatectomy according to D'Amico risk criteria.
abstract: BACKGROUND
  To analyze the trifecta outcome (continence, potency, and cancer control) in 300 cases of robotic-assisted laparoscopic radical prostatectomy (RARP).
  
  
  METHODS
  A prospective assessment of outcomes in 300 consecutive patients that underwent a RARP performed by a single surgeon. Patients were grouped according to D'Amico risk criteria: Group I consisted of 'low-risk' cases (n = 64), Group II consisted of 'intermediate-risk' cases (n = 88), and Group III consisted of 'high-risk' cases (n = 148). Patients were evaluated for perioperative complications and the trifecta outcome.
  
  
  RESULTS
  The operation time, blood loss, post-operative stay, duration of urethral catheterization, and perioperative complication rate were similar among all groups. The incidence of bilateral neurovascular bundle (NVB) preservation was significantly decreased with the increasing risk of cases (P < 0.001). The continence rates at the 1-week, 1-month, 3-month, 6-month, and 12-month follow-ups did not differ significantly between groups. The potency rates at the 12-month follow-up were not significantly different. The positive surgical margin and positive lymph node metastasis rate increased with the increasing risk of cases (P < 0.001). The biochemical recurrence rate (BCR, PSA >0.2 ng/mL) was 3.1, 11.36, and 19.59% in Groups I, II and III, respectively (P = 0.004). The trifecta outcome for RARP with bilateral NVB preservation showed no significant differences among groups.
  
  
  CONCLUSIONS
  Undergoing a RARP is safe and feasible in high-risk prostate cancer patients. Compared to low-risk and intermediate-risk groups, the high-risk group had a significant higher incidence of positive surgical margin, positive lymph node metastasis, and BCR rate.
authors.affiliation: Division of Urology, Department of Surgery, Taichung Veterans General Hospital, National Yang-Ming University, Taiwan. ycou228@gmail.com
authors.forename: Y C
authors.initials: YC
authors.lastname: Ou
authors.forename: C K
authors.initials: CK
authors.lastname: Yang
authors.forename: J
authors.initials: J
authors.lastname: Wang
authors.forename: S W
authors.initials: SW
authors.lastname: Hung
authors.forename: C L
authors.initials: CL
authors.lastname: Cheng
authors.forename: A K
authors.initials: AK
authors.lastname: Tewari
authors.forename: V R
authors.initials: VR
authors.lastname: Patel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010410:Penile Erection; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D012371:Robotics; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology*