To evaluate the safety and outcomes of robot-assisted radical prostatectomy (RARP) in renal transplant recipients (RTRs) based on available literature.
Materials and Methods:
A literature search was performed using PubMed, Embase, and Web of Science through “robot” AND “prostatectomy” AND “transplant.” Three authors separately reviewed the records to select the relevant articles with any discrepancies solved by open discussion. Patient age, prostate-specific antigen, Gleason score, and tumor stage were recorded as well as intraoperative and postoperative complications, length of stay, surgical margin status, and disease recurrence, if provided. The operative techniques and modification/adjustments to standard port placements were also reviewed. We also include our case report in this review.
Results:
We retrieved 10 articles reporting clinical data on RARP for kidney transplant patients, including 5 case series (level 4) and 5 case reports (level 4). A total of 35 kidney transplant recipients undergoing RARP were analyzed in this systematic review, one case in our institution included. None of the cases had major technical difficulties precluding the operation. Technical modifications to the standard technique were described in 10 of the 11 articles specifically including modifications to port placement (54% of patients), development of the space of Retzius (60% of patients), and performance of lymphadenectomy. Mean operative time was 220 minutes. Perioperative complication rate was 17.1% (6 of 35 patients), with only one Clavien III or greater complication. The rate of positive surgical margins was found to be 31.4%. Data on biochemical recurrence revealed a combined rate of 18.1%.
Conclusions:
RARP is technically feasible for treating localized prostate cancer in RTRs. Graft function did not deteriorate in any patient. Modifications to the standard technique should be considered specifically for port placement, development of the space of Retzius, and performance of lymphadenectomy. Oncologic outcomes remain difficult to interpret given the small number of reported cases.
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References
1.
HartA, SmithJM, SkeansMA, et al.OPTN/SRTR 2015 annual data report: Kidney. Am J Transplant, 2017; 17(Suppl 1):21–116.
2.
.System USRD. 2007 USRDS Annual Data Report. Bethesda, MD: National Institutes of Health – National Institute of Diabetes and Digestive and Kidney Diseases, 2007.
3.
CormierL, LechevallierE, BarrouB, et al.Diagnosis and treatment of prostate cancers in renal-transplant recipients. Transplantation, 2003; 75:237–239.
4.
BinsalehS. Diagnosis and treatment of prostate cancer in renal-transplant recipients. Int Urol Nephrol, 2012; 44:149–155.
5.
CampagnariJC, RibeiroLA, ManginiM, CampagnariM, RodriguesPR, D'ImperioM. Localized prostatic cancer in patients submitted to renal transplant. Int Braz J Urol, 2002; 28:330–334.
6.
CarvalhoJA, NunesP, DinisPJ, et al.Prostate cancer in renal transplant recipients: Diagnosis and treatment. Transplant Proc, 2017; 49:809–812.
7.
HallEC, PfeifferRM, SegevDL, EngelsEA. Cumulative incidence of cancer after solid organ transplantation. Cancer, 2013; 119:2300–2308.
8.
PiselliP, SerrainoD, SegoloniGP, et al.Risk of de novo cancers after transplantation: Results from a cohort of 7217 kidney transplant recipients, Italy 1997–2009. Eur J Cancer, 2013; 49:336–344.
9.
SampaioMS, ChoYW, QaziY, BunnapradistS, HutchinsonIV, ShahT. Posttransplant malignancies in solid organ adult recipients: An analysis of the U.S. National Transplant Database. Transplantation, 2012; 94:990–998.
10.
YanikEL, GustafsonSK, KasiskeBL, IsraniAK, SnyderJJ, HessGP, EngelsEA, SegevDL. Sirolimus use and cancer incidence among US kidney transplant recipients. Am J Transplant, 2015; 15:129–136.
11.
GhaziA, ErturkE, JosephJV. Modifications to facilitate extraperitoneal robot-assisted radical prostatectomy post kidney transplant. JSLS J Soc Laparoendosc Surg, 2012; 16:314–319.
12.
KleinclaussF, GiganteM, NeuzilletY, et al.Prostate cancer in renal transplant recipients. Nephrol Dial Transplant, 2008; 23:2374–2380.
13.
HafronJ, FogartyJD, WiesenA, MelmanA. Surgery for localized prostate cancer after renal transplantation. BJU Int, 2005; 95:319–322.
14.
MouzinM, BachaudJM, KamarN, GaméX, VaessenC, RischmannP, RostaingL, MalavaudB. Three-dimensional conformal radiotherapy for localized prostate cancer in kidney transplant recipients. Transplantation, 2004; 78:1496–1500.
15.
ElkentaouiH, RobertG, PasticierG, et al.Therapeutic management of de novo urological malignancy in renal transplant recipients: The experience of the French Department of Urology and Kidney Transplantation from Bordeaux. Urology, 2010; 75:126–132.
16.
HodaMR, HamzaA, GrecoF, WagnerS, ReicheltO, HeynemannH, FischerK, FornaraP. Management of localized prostate cancer by retropubic radical prostatectomy in patients after renal transplantation. Nephrol Dial Transplant, 2010; 25:3416–3420.
17.
KinahanTJ, McLoughlinMG, MansonAD. Radical prostatectomy for localized prostatic carcinoma in the renal transplant patient. J Urol, 1991; 146:104–107.
YiouR, SalomonL, ColombelM, PatardJJ, ChopinD, AbbouCC. Perineal approach to radical prostatectomy in kidney transplant recipients with localized prostate cancer. Urology, 1999; 53:822–824.
20.
DoerflerA, VaessenC, GosseinePN, BarrouB, RichardF. Laparoscopic radical prostatectomy in kidney transplant patient: Our first experience-a case report. Transplant Proc, 2009; 41:713–715.
21.
RobertG, ElkentaouiH, PasticierG, et al.Laparoscopic radical prostatectomy in renal transplant recipients. Urology, 2009; 74:683–687.
22.
ShahKK, KoDS, MercerJ, DahlDM. Laparoscopic radical prostatectomy in a renal allograft recipient. Urology, 2006; 68:672.e5–672.e7.
23.
ThomasAA, NguyenMM, GillIS. Laparoscopic transperitoneal radical prostatectomy in renal transplant recipients: A review of three cases. Urology, 2008; 71:205–208.
24.
.Group OLoEW. The Oxford 2011 Levels of Evidence. Oxford: Centre for Evidence-Based Medicine, 2011.
EinarsonTR. Pharmacoeconomic applications of meta-analysis for single groups using antifungal onychomycosis lacquers as an example. Clin Ther, 1997; 19:559–569; discussion 538. discussion 38–39.
27.
HozoSP, DjulbegovicB, HozoI. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol, 2005; 5:13.
28.
GulHC, ErdemH, BekS. Overview of neurobrucellosis: A pooled analysis of 187 cases. Int J Infect Dis, 2009; 13:e339–e343.
29.
Le ClercQC, LecornetE, LeonG, RigaudJ, GlemainP, BranchereauJ, KaramG. Technical feasibility of robot-assisted laparoscopic radical prostatectomy in renal transplant recipients: Results of a series of 12 consecutive cases. Can Urol Assoc J, 2015; 9:E490–E493.
30.
Moreno SierraJ, Ciappara PaniaguaM, Galante RomoMI, Senovilla PérezJL, Redondo GonzálezE, Galindo HerreroMI, Novo GómezN, Blázquez IzquierdoJ. Robot assisted radical prostatectomy in kidney transplant recipients. Our clinical experience and a systematic review. Urol Int, 2016; 97:440–444.
PlagakisS, ForemanD, SutherlandP, FullerA. Transperitoneal robot-assisted radical prostatectomy should be considered in prostate cancer patients with pelvic kidneys. J Endourol Case Rep, 2016; 2:38–40.
33.
JhaveriJK, TanGY, ScherrDS, TewariAK. Robot-assisted laparoscopic radical prostatectomy in the renal allograft transplant recipient. J Endourol, 2008; 22:2475–2479.
34.
IizukaJ, HashimotoY, KondoT, et al.Robot-assisted radical prostatectomy for localized prostate cancer in asian renal transplant recipients. Transplant Proc, 2016; 48:905–909.
35.
GettmanMT, HoznekA, SalomonL, KatzR, BorkowskiT, AntiphonP, LobontiuA, AbbouCC. Laparoscopic radical prostatectomy: Description of the extraperitoneal approach using the da Vinci robotic system. J Urol, 2003; 170:416–419.
36.
SkareckyDW. Robotic-assisted radical prostatectomy after the first decade: Surgical evolution or new paradigm. ISRN Urol, 2013; 2013:1–22.
37.
JenjitranantP, SangkumP, SirisreetreeruxP, ViseshsindhW, PatcharatrakulS, KongcharoensombatW. Retzius space preservation technique for robotic-assisted laparoscopic radical prostatectomy in a kidney transplant patient: First case in Thailand and our first experience. Transplant Proc, 2016; 48:3130–3133.
38.
SmithDL, JellisonFC, HeldtJP, et al.Robot-assisted radical prostatectomy in patients with previous renal transplantation. J Endourol, 2011; 25:1643–1647.
39.
WagenerN, Nyarangi-DixJN, TeberD, ZeierM, HohenfellnerM. Applicability of robot-assisted laparoscopic radical prostatectomy in renal allograft recipients. Transplant Proc, 2012; 44:1287–1292.
40.
Leyh-BannurahSR, BudäusL, PompeR, et al.North American population-based validation of the national comprehensive cancer network practice guideline recommendation of pelvic lymphadenectomy in contemporary prostate cancer. Prostate, 2017; 77:542–548.
41.
PileckiMA, McGuireBB, JainU, KimJY, NadlerRB. National multi-institutional comparison of 30-day postoperative complication and readmission rates between open retropubic radical prostatectomy and robot-assisted laparoscopic prostatectomy using NSQIP. J Endourol, 2014; 28:430–436.
42.
WallerstedtA, TyritzisSI, ThorsteinsdottirT, et al.Short-term results after robot-assisted laparoscopic radical prostatectomy compared to open radical prostatectomy. Eur Urol, 2015; 67:660–670.
43.
BhandariA, McIntireL, KaulSA, HemalAK, PeabodyJO, MenonM. Perioperative complications of robotic radical prostatectomy after the learning curve. J Urol, 2005; 174:915–918.
44.
NovaraG, FicarraV, MocellinS, et al.Systematic review and meta-analysis of studies reporting oncologic outcome after robot-assisted radical prostatectomy. Eur Urol, 2012; 62:382–404.
45.
CoelhoRF, ChauhanS, OrvietoMA, PalmerKJ, RoccoB, PatelVR. Predictive factors for positive surgical margins and their locations after robot-assisted laparoscopic radical prostatectomy. Eur Urol, 2010; 57:1022–1029.
LissM, OsannK, OrnsteinD. Positive surgical margins during robotic radical prostatectomy: A contemporary analysis of risk factors. BJU Int, 2008; 102:603–608.
48.
MarchettiPE, ShikanovS, RazmariaAA, ZagajaGP, ShalhavAL. Impact of prostate weight on probability of positive surgical margins in patients with low-risk prostate cancer after robotic-assisted laparoscopic radical prostatectomy. Urology, 2011; 77:677–681.
49.
PatelVR, CoelhoRF, RoccoB, et al.Positive surgical margins after robotic assisted radical prostatectomy: A multi-institutional study. J Urol, 2011; 186:511–516.
50.
ShererBA, WarriorK, GodlewskiK, HertlM, OlaitanO, NehraA, DeaneLA. Prostate cancer in renal transplant recipients. Int Braz J Urol, 2017; 43:1021–1032.
51.
DavidKM, MorrisJA, SteffenBJ, Chi-BurrisKS, GotzVP, GordonRD. Mycophenolate mofetil vs. azathioprine is associated with decreased acute rejection, late acute rejection, and risk for cardiovascular death in renal transplant recipients with pre-transplant diabetes. Clin Transplant, 2005; 19:279–285.
52.
RobsonR, CeckaJM, OpelzG, BuddeM, SacksS. Prospective registry-based observational cohort study of the long-term risk of malignancies in renal transplant patients treated with mycophenolate mofetil. Am J Transplant, 2005; 5:2954–2960.
53.
KauffmanHM, CherikhWS, ChengY, HantoDW, KahanBD. Maintenance immunosuppression with target-of-rapamycin inhibitors is associated with a reduced incidence of de novo malignancies. Transplantation, 2005; 80:883–889.
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