title: Robot-assisted radical prostatectomy in the setting of previous abdominal surgery: Perioperative results, oncological and functional outcomes, and complications in a single surgeon's series.
abstract: BACKGROUND
  Data on safety and efficacy of robot-assisted radical prostatectomy (RARP) after previous abdominal surgery are scarce. Hence, we assessed perioperative, oncological and functional outcomes, and complications of RARP in patients with previous abdominal surgery after 1-year minimum follow-up.
  
  
  METHODS
  Prospectively collected data from 339 consecutive patients undergoing transperitoneal RARP by a single surgeon (AM) between November 2008 and May 2014 were analysed. Complications were classified according to Modified Clavien System. Biochemical recurrence (BCR) was defined as two consecutive PSA values ≥ 0.2 ng/ml. Functional outcomes were assessed using validated, self-administered questionnaires. In particular, only patients undergoing nerve-sparing RARP with no erectile dysfunction (baseline IIEF-5 score >21) and no use of phosphodiesterase-5 inhibitors preoperatively who were interested in erections and required no adjuvant therapy (radiation, orchiectomy and androgen-deprivation therapy) were evaluated concerning potency recovery. Patients without and with previous abdominal surgery were compared using Mann-Whitney and chi-square tests (or Fisher exact test).
  
  
  RESULTS
  On 339 patients, 247 (71.6%) had not undergone previous abdominal surgery (Group 1) and 92 (28.4%) were pre-operated (Group 2). There were no statistically significant differences between Groups 1 and 2 regarding mean operative time (260 vs. 257 min; p = 0.597), median number of resected nodes (16 vs. 17; p = 0.484), mean length of stay (7.2 vs. 7.1 d; p = 0.151), positive surgical margin (12.5% vs. 16.3%; p = 0.233) and complication rates (26.7% vs. 31.5%; p = 0.187). Median (IQR) follow-up was 36 (12-48) months. For Groups 1 and 2, BCR-free survival rates were 78.5% and 79.8% (p = 0.467); continence rates were 97.9% and 100% (p = 0.329), whereas a potency recovery was achieved in 69.5% and 62.2% of patients (p = 0.460), respectively.
  
  
  CONCLUSIONS
  Transperitoneal RARP is a safe and efficient treatment for clinically localised prostate cancer even in patients with previous abdominal surgery. However, further studies with higher number of patients are warranted.
authors.affiliation: Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland; Dept. of Obstetrics and Gynecology Sciences and Urologic Sciences, 'Sapienza' University, Rome, Italy. Electronic address: gb.dipierro@libero.it.
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Di Pierro
authors.affiliation: Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland; Dept. of Obstetrics and Gynecology Sciences and Urologic Sciences, 'Sapienza' University, Rome, Italy. Electronic address: grandepietro@gmail.com.
authors.forename: Pietro
authors.initials: P
authors.lastname: Grande
authors.affiliation: Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland. Electronic address: livio.mordasini@luks.ch.
authors.forename: Livio
authors.initials: L
authors.lastname: Mordasini
authors.affiliation: Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland. Electronic address: hansjoerg.danuser@luks.ch.
authors.forename: Hansjörg
authors.initials: H
authors.lastname: Danuser
authors.affiliation: Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland. Electronic address: a.mattei@gmx.ch.
authors.forename: Agostino
authors.initials: A
authors.lastname: Mattei
mesh_terms: D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects*; D008297:Male; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects*; D000267:Tissue Adhesions / Q000209:etiology / Q000601:surgery*
keywords: Complications; Oncological and functional outcomes; Perioperative; Previous abdominal surgery; Prostate cancer; Robot-assisted radical prostatectomy