Comparative study of open versus robotic radical prostatectomy in renal transplant recipients and review of the literature

Prostate cancer is the most common cancer among men, including renal transplant recipients (RTRs), who are becoming more numerous owing to improvements in transplant outcomes. Although radical prostatectomy (RP) remains a common curative procedure, RTRs present unique surgical challenges due to their altered pelvic anatomy and the need for immunosuppression. This study aimed to compare the perioperative, oncological, and functional outcomes of open radical prostatectomy (ORP) and robot-assisted radical prostatectomy (RARP) performed by two skilled surgeons on renal transplant recipients (RTRs). Nineteen RTRs with localized prostate cancer who underwent RP between 1997 and 2023 were included in this retrospective, monocentric study. The patients were divided into two groups: RARP (n=8) and ORP (n=11). We analyzed preoperative data, perioperative metrics (blood loss, operative time), renal function, oncological outcomes (PSA), and functional outcomes (erectile function, continence). Patients in The ORP group were older when they received their transplants. Significantly less blood loss was associated with RARP (median 50 mL vs. 500 mL, p<0.001). The renal outcomes and operating times were similar between the groups. There were no significant differences in oncological outcomes, such as surgical margins and PSA control. Although there was little information on erectile function, continence was usually maintained in these patients. RTRs can benefit from both ORP and RARP, with RARP showing advantages in terms of postoperative recovery and blood conservation. Robotic surgery may increase perioperative safety while maintaining oncological outcomes. To confirm these results and assess more recent surgical techniques developed specifically for RTRs, larger prospective studies are required.