Assessing the detrimental effect of the covid-19 pandemic on the outcomes of robot-assisted radical prostatectomy. A single-institutional analysis

ABSTRACT

Author of the study The coronavirus disease 2019 (COVID-19) pandemic is leading to delays in the treatment of several urological malignancies. To determine the impact of COVID-19 pandemic on the outcomes of patients with prostate cancer (PCa) treated with robotassisted radical prostatectomy (RARP) at a single tertiary-care center. Material(s) and Method(s) A retrospective study on patients who underwent a RARP at a single institution in two pre-specified time intervals, namely March-July 2019 (pre-COVID) and March-July 2020 (during-COVID), was conducted. Surgical waiting time (SWT) was defined as the period from prostate biopsy to surgery. All patients in the pre-COVID era underwent a specific pre- rehabilitation program, consisting of preoperative pelvic floor muscle exercises starting at least 1-month before RARP, as well as counselling with a prostate casemanager. After surgery, all patients underwent a structured follow-up both with physiotherapists and andrologists. During the COVID period, this specific program was not guaranteed. Continence recovery was defined as no use of pad, while erectile function (EF) recovery was defined as an erection sufficient for intercourse. Oncological outcomes were defined as biochemical recurrence and/or imaging evidence of progression. Result(s) A total of 249 patientswere eligible for analysis,136 (54.6%) in the pre-COVID and 113 (45.4%) in the COVID time-span. No significant differences in baseline characteristics, clinical and pathological features were observed between the two groups. Median SWT was 2.9 (2.5-3.1) in 2019 and 5.8 (5.0-7.0) in 2020. Median (IQR) follow-up was 25 (15-27) months. At 45 days, 6 months and 1 year follow-up no significant differences were observed in biochemical recurrence and progression- free survival rates. Biochemical recurrence at last followup was observed in 11 (8.1%) patients of pre-COVID and 3 (2.7%) patients during COVID. At the first follow-up visit 45 days after RARP, 49 (36.0%) patientswere continent and 6 (4.4%) patients had preserved EF in the pre-COVID group period, as compared to 8 (7.08%) and 0 (0%) in the COVID group (p < 0.001 and p = 0.072 respectively). At 6 months, 131 (96.3%) patients `were continent and 30 (22.1%) patients had EF recovery in pre-COVID group, as compared to 77 (68.14%) and 9 (8.0%) in the COVID group (p < 0.001). Finally, at 1 year 134 (98.5%) patients were continent and 50 (36.8%) patients were fully potent in the pre- COVID period, compared with 96 (85.0%) and 19 (16.8%) during COVID (p < 0.001). Conclusion(s) The use of a pre-rehabilitation program, which was routinely used in the pre-COVID era, appears to significantly improve the functional outcomes of patients subjected to RARP. On the other side, surgical delay does not appear to significantlyworsen oncological outcomes, even though these findings are limited by the short followup time. Copyright © 2022 European Association of Urology. Published by Elsevier B.V.