Abstract：Objective: To discuss the operative difficulties and skills in robot-assisted laparoscopic radical prostatectomy (RALP) in the management of complicated prostate cancer so as to improve the operation technique. Methods: The clinical data of 126 cases of complicated prostate cancer receiving RALP from January 2013 to February 2017 in our department were collected and retrospectively analyzed, in which 48 cases received endocrine therapy (38.1%), there were 33 cases after TURP or open prostatectomy (26.2%), 29 cases of large volume prostate cancer (the volume of prostate ≥100 mL) (23.0%), 16 cases (12.7%) of middle lobe of prostate protruding into bladder. Pelvic lymphadenectomy was performed at the same time for high-risk prostate cancer. Results: All the 126 cases were operated successfully and there was no open conversion, no rectal injury and no blood transfusion. The average blood loss was 95 mL (range, 45-330 mL). Average operative time was 136 min (86-191 min), and the average postoperative hospital stay was 7.8 d (5-12 d). The pathological margin was positive in 15 cases (11.9%), and lymph nodes were positive in 7 cases (5.6%). The urine leak occurred in 3 cases, and lymphatic leak in 5 cases, which were cured 1-3 weeks after operation. Anastomotic stricture occurred in one case. After urethral dilatation, the urine was unobstructed. The patients were followed up for 26 (3-46) months after RALP. The continence rate was 86.5% within 1 year. Biochemical recurrence rate was 7.1%. Conclusions: RALP is a safe and efficacious surgical modality in the management of complicated prostate cancer. Through reasonable technical optimization, the operation difficulty can be obviously reduced.
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