Anterior versus posterior first approach for robot assisted radical prostatectomy-perioperative, functional, and oncological outcomes.

Background: Robot-assisted radical prostatectomy (RARP) is commonly performed using either the anterior (AF) or posterior first (PF) approaches, depending upon where the dissection begins. While there is some data comparing outcomes of conventional RARP and Retzius sparing posterior RARP, there is limited data comparing outcomes between the AF and PF approaches to conventional RARP. We compared the two approaches in terms of perioperative, functional, and oncological outcomes. Materials and methods: We retrospectively reviewed our data of RARP performed between 2014 and 2023 and identified 258 patients who had undergone the procedure using one of the two approaches. The choice of approach was dependent upon the surgeon with five surgeons with varying experience having performed all surgeries. We compared the two cohorts for perioperative, functional, and oncological outcomes. Results: One hundred thirty-nine patients underwent RARP using the AF approach and 119 the PF approach. AF group were younger and had larger prostate volume at baseline. Operative time, blood loss was higher in the PF approach, whereas the positive surgical margins, biochemical recurrence, need for adjuvant therapy, potency, and continence parameters were similar between the two groups. Conclusions: Our data suggests that the AF approach offers certain advantages in operative outcomes in RARP. However, this could be due to surgeon experience and needs better-controlled studies for validation.