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Page 6 of 8 Wagaskar et al. Mini-invasive Surg 2022;6:14 https://dx.doi.org/10.20517/2574-1225.2021.106

[23]
Preisser et al. compared perioperative results between CRP and RP for localized prostate cancer and
reported that CRP results in more complications and longer hospital stays. However, CRP also reduces
long-term local complications, including bleeding, bladder outlet obstruction, and ureteral obstruction.
Published results of CR-related complication rates were 20% compared to 53% for systemic therapy and 47%
for men who received radiotherapy. Surgery complication rates in our review series ranged from 5%-18%.

The debate surrounding RARP vs. ORP is unlikely to have a clear resolution soon, but an increasing
number of surgeons are trained in, and routinely perform, RARP. The benefits of the technique have been
described for nerve sparing and continence or sexual function preservation, and the robotic approach
continues to gain acceptance for a larger number of indications. Numerous studies show that the robotic
[24]
approach is increasingly becoming the first-choice strategy of urologists, even in metastatic cases . In a
2010 study on CRP for OMPC patients, only 9 robotic CRP procedures were conducted vs. 104 open
procedures . Just a few years later, Sooriakumaran et al. conducted a multicenter study where the choice
[7]
[11]
of approach was left to the clinician’s discretion and in one center, all 5 procedures (100%) were performed
with robot-assisted procedures. In 2017 as described in Jang et al. , 38 robotic surgeries were assessed;
[12]
[18]
followed by Poelaert et al. who described the outcomes of 17 patients, 16 of whom underwent robotically
assisted CPR. In this study, the authors found return of 70.6% continence with no local symptoms in the
surgery group vs. 44.8% in the non-RARP group (P = 0.014). Obstructive voiding with the need for medical
intervention was present in 37.9% of patients who did not have robotic surgery and 6.8% had ureteric
obstruction with 3.4% requiring JJ-stenting. Three months after CRP, 29.4% and 11.8% of patients suffered
grade 1 and 2 complications, respectively. Robotic surgery was shown to be as safe in OMPC as in non-
metastatic disease with acceptable surgical morbidity and oncological outcomes. In Poelaert et al. , there
[18]
were no high-grade (> grade 2) complications. While 41.2% of patients suffered low-grade complications,
outcomes appeared to be improved over the Heidenreich et al. open CRP series with a lower 39.1%
[7]
complication rate, but with 13% of patients experiencing grade 3 complications. A recent randomized
controlled trial of surgery plus best systemic therapy vs. best systematic therapy alone for men with OMPC
has completed accrual in the UK (the TROMBONE trial) and is currently awaiting publication .
[25]

CONCLUSION
Reviewing the relevant literature, we find that RP and RARP in particular, appear to be feasible and safe for
patients diagnosed with oligometastatic prostate cancer, providing oncological benefit for this growing
population of patients with low volume metastasis. Future studies should address the selection of patients
for potential multimodal therapeutic strategies.

DECLARATIONS
Acknowledgment
We thank Ms. Sima Rabinowitz for editorial assistance.

Authors’ contributions
Made substantial contributions to conception and design of the study and manuscript writing: Wagaskar
VG, Barthe F
Manuscript reviewing and critical analysis: Sooriakumaran P, Martini A
Contributed to manuscript writing as well as provided administrative, technical, and material support:
Tewari A