Comparison of perioperative and short-term oncological outcomes between single-port and multiport robot-assisted radical prostatectomy for high-risk prostate cancer

Comparison of perioperative and short-term oncological outcomes between single-port and multiport robot-assisted radical prostatectomy for high-risk prostate cancer | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of perioperative and short-term oncological outcomes between single-port and multiport robot-assisted radical prostatectomy for high-risk prostate cancer Hongzhi Wang, Weiqi Zhao, Jialong Zhang, Sheng Tai, Chaozhao Liang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9613058/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background and Objectives: Robot-assisted radical prostatectomy is widely used for the treatment of prostate cancer. Compared with conventional multiport robotic surgery, single-port robotic surgery may reduce surgical trauma and facilitate postoperative recovery. However, most comparative studies of single-port and multiport robot-assisted radical prostatectomy have included mixed-risk populations. Evidence in patients with high-risk prostate cancer remains limited. These patients often have a higher risk of local progression, lymph node involvement and postoperative recurrence. Therefore, short-term pathological and oncological safety should be carefully assessed. This study compared perioperative, pathological, and early PSA outcomes between EDGE SP1000 single-port robot-assisted radical prostatectomy (SP-RARP) and da Vinci Xi multiport robot-assisted radical prostatectomy (MP-RARP) in patients with high-risk prostate cancer. Methods: This single-center cohort study included patients with high-risk prostate cancer who underwent robot-assisted radical prostatectomy at the First Affiliated Hospital of Anhui Medical University between March 2025 and April 2026. Patients were assigned to the SP-RARP or MP-RARP group according to the robotic platform used. The initial cohort included 45 patients in the SP-RARP group and 45 patients in the MP-RARP group. To reduce selection bias from baseline differences, 1:1 propensity score matching was performed. Matching variables included age, body mass index, log10 preoperative PSA, MRI-measured prostate volume, preoperative hemoglobin, biopsy Grade Group 5, and neoadjuvant therapy. After matching, 35 patients in each group were included. Perioperative outcomes, pathological outcomes and early PSA outcomes were compared. Continuous variables were reported as medians with interquartile ranges. Categorical variables were reported as numbers and percentages. Covariate balance after matching was assessed using standardized mean differences. Multivariable adjusted analyses were also performed. Main Findings: For perioperative outcomes, operative time was 133.00 (120.00–151.50) min in the SP-RARP group and 115.00 (101.50–157.00) min in the MP-RARP group, with no significant difference (P = 0.324). Hemoglobin decrease was 18.00 (14.00–31.00) g/L and 20.50 (13.25–24.00) g/L, respectively (P = 0.331). The percentage decrease in hemoglobin was 13.64% (9.62%–20.45%) and 14.70% (10.16%–17.08%), respectively (P = 0.380). The median postoperative hospital stay was 4.00 days in both groups: 4.00 (4.00–4.00) days in the SP-RARP group and 4.00 (4.00–5.00) days in the MP-RARP group (P = 0.363). For pathological outcomes, there were no significant differences in positive surgical margin rate, pelvic lymph node dissection rate, or lymph node positivity rate. The positive surgical margin rates were 48.6% and 54.3%, respectively (P = 0.811). For early PSA outcomes, early PSA levels were 0.013 (0.010–0.040) ng/mL in the SP-RARP group and 0.016 (0.010–0.054) ng/mL in the MP-RARP group (P = 0.610). The rates of PSA ≥ 0.03 ng/mL were 29.4% and 31.2%, respectively (P = 1.000). In multivariable adjusted analyses, SP-RARP was not significantly associated with operative time, hemoglobin decrease, percentage decrease in hemoglobin, postoperative hospital stay, positive surgical margin, or early PSA ≥ 0.03 ng/mL. Conclusion: In this single-center propensity score-matched cohort, EDGE SP1000 SP-RARP achieved perioperative, pathological, and early PSA outcomes comparable to those of da Vinci Xi MP-RARP in patients with high-risk prostate cancer. SP-RARP was not associated with higher rates of positive surgical margins, lymph node positivity or detectable early PSA. These findings suggest that EDGE SP1000 SP-RARP is feasible and shows short-term oncological safety in high-risk prostate cancer patients. Introduction Prostate cancer is one of the most common malignancies in men. Treatment decisions are challenging for patients with high-risk localized or locally advanced disease. These patients have higher risks of local invasion, lymph node metastasis, biochemical recurrence, and disease progression [ 1 – 4 ]. Current guidelines support radical prostatectomy as an important local treatment option in selected patients [ 5 ]. Pelvic lymph node dissection is often considered [ 6 , 7 ]. In this setting, surgery should provide acceptable perioperative safety [ 8 ]. It should also preserve oncological quality, including margin status, pathological stage, and postoperative PSA clearance [ 9 , 10 ]. Robot-assisted radical prostatectomy has been widely used for prostate cancer [ 11 , 12 ]. Multiport robot-assisted radical prostatectomy (MP-RARP) is a mature technique and remains one of the main surgical approaches [ 13 ]. With the development of single-port platforms, single-port robot-assisted radical prostatectomy (SP-RARP) has entered clinical practice [ 14 , 15 ]. Previous studies in mixed-risk prostate cancer cohorts suggest that SP-RARP may reduce postoperative pain, hospital stay, and catheterization time. Early functional and oncological outcomes appear comparable to those of MP-RARP [ 16 – 19 ]. However, most comparisons between SP-RARP and MP-RARP have included mixed-risk populations [ 16 , 19 ]. Evidence specific to high-risk prostate cancer remains limited. High-risk patients differ from low- and intermediate-risk patients in tumor biology, local extent, lymph node risk, and the need for lymph node dissection [ 2 , 20 – 22 ]. Findings from general prostate cancer cohorts may not apply directly to this group. It remains unclear whether the potential perioperative benefits of SP-RARP can be achieved without compromising pathological or early oncological outcomes. This study compared perioperative, pathological, and early oncological outcomes between SP-RARP and MP-RARP in patients with high-risk prostate cancer. The aim was to provide clinical evidence for surgical decision-making in this high-risk population. Patients and methods This was a single-center cohort study conducted at the First Affiliated Hospital of Anhui Medical University. The study was approved by the institutional ethics committee (PJ 2025-02-81). Patients with high-risk prostate cancer who underwent robot-assisted radical prostatectomy (RARP) between March 2025 and April 2026 were included. Patients were grouped according to the surgical platform. The SP-RARP group underwent surgery using the EDGE SP1000 single-port robotic system. The MP-RARP group underwent surgery using the da Vinci Xi multiport robotic system. All operations were performed by two experienced surgeons from the same surgical team. The inclusion criteria were as follows: histologically confirmed prostate adenocarcinoma; high-risk localized or locally advanced prostate cancer; eligibility for radical prostatectomy after preoperative evaluation; clinical stage cT1-T3aN1M0; life expectancy greater than 10 years; and written informed consent for surgery and study participation. High-risk prostate cancer was defined according to major international risk stratification systems. Patients were considered high risk if they had any of the following: preoperative PSA > 20 ng/mL, biopsy Grade Group 4–5 or Gleason score 8–10, or clinical stage > = cT3. The exclusion criteria were distant metastasis on preoperative imaging, a history of major pelvic surgery or pelvic radiotherapy. All patients underwent preoperative serum prostate-specific antigen testing, prostate magnetic resonance imaging (MRI), prostate biopsy, and staging examinations when indicated. Baseline data included age, weight, height, body mass index (BMI), preoperative PSA, biopsy Gleason score or Grade Group, MRI-measured prostate volume, clinical stage and imaging stage. In patients scheduled for pelvic lymph node dissection, the extent of dissection and pathological nodal results were also recorded. All patients underwent RARP under general anesthesia. The EDGE SP1000 group was treated using the single-port robotic platform. The da Vinci Xi group was treated using the standard multiport platform. Both procedures followed the principles of radical prostatectomy. Pelvic lymph node dissection was performed according to preoperative tumor features and intraoperative findings. In the EDGE SP1000 group, an extraperitoneal approach was used. A midline incision of about 4 cm was made between the umbilicus and the pubic symphysis. After creation of the extraperitoneal space, a multichannel single-port device was inserted. When needed, a 12-mm assistant trocar was placed in the right lower abdomen for suction, clipping, suture transfer, and specimen handling. A pelvic drain was placed at the end of the procedure according to intraoperative findings. The da Vinci Xi group underwent surgery with the standard multiport approach and port layout used at our center. 2.1. Study endpoints The main outcomes were perioperative, pathological, and early follow-up outcomes. The primary endpoints included operative time, postoperative hemoglobin decrease, postoperative hospital stay, positive surgical margin, number of lymph nodes removed, number of positive lymph nodes, and PSA level at approximately 1 month after surgery. 2.2. Statistical analysis Continuous variables were reported as mean +/- standard deviation or median (interquartile range), depending on distribution. Between-group comparisons used the independent-samples t test or the Mann-Whitney U test. Categorical variables were reported as numbers and percentages. Between-group comparisons used the chi-square test or Fisher exact test. Propensity score matching and multivariable regression were used to reduce selection bias and confounding. The propensity score model included age, BMI, log10 preoperative PSA, MRI-measured prostate volume, preoperative hemoglobin, biopsy Grade Group 5, and neoadjuvant therapy. Covariate balance after matching was assessed using the standardized mean difference (SMD). Multivariable models were adjusted for log10 preoperative PSA, MRI-measured prostate volume, biopsy Grade Group 5, and neoadjuvant therapy. All tests were two-sided. A P value < 0.05 was considered statistically significant. Results 3.1 Patient inclusion and propensity score matching A total of 90 patients with high-risk prostate cancer who underwent RARP were included. There were 45 patients in the SP-RARP group and 45 patients in the MP-RARP group. To reduce baseline imbalance, 1:1 propensity score matching was performed using preoperative variables. The matching variables included age, BMI, log10 preoperative PSA, MRI-measured prostate volume, preoperative hemoglobin, biopsy Grade Group 5, and neoadjuvant therapy. Hypertension and diabetes mellitus were not included in the matching model. After matching, 35 SP-RARP patients and 35 MP-RARP patients were included in the main analysis. Covariate balance was evaluated using the SMD. 3.2 Baseline characteristics before and after matching Baseline characteristics before matching are shown in Table 1 . Compared with the SP-RARP group, the MP-RARP group had higher preoperative PSA levels, a higher proportion of PSA > 20 ng/mL, larger MRI-measured prostate volume and a higher rate of neoadjuvant therapy. These findings indicated baseline imbalance in the original cohort. After 1:1 propensity score matching, most key baseline variables were generally comparable between the two groups (Table 2 ). The median age was 68.00 (62.50–74.00) years in the SP-RARP group and 71.00 (63.50–75.00) years in the MP-RARP group (P = 0.672). The median BMI was 23.74 (21.77–25.12) kg/m² and 23.53 (22.09–25.73) kg/m², respectively (P = 0.991). The median preoperative PSA was 12.24 (8.19–14.74) ng/mL and 13.79 (10.90-36.75) ng/mL, respectively (P = 0.122). PSA > 20 ng/mL was present in 20.0% and 34.3% of patients, respectively (P = 0.282). Biopsy Grade Group 5 was present in 28.6% and 31.4% of patients, respectively (P = 1.000). The SMD analysis showed improved balance for age, BMI, preoperative PSA, and biopsy Grade Group 5 after matching. Residual differences remained for MRI-measured prostate volume, preoperative hemoglobin, PSA > 20 ng/mL, and neoadjuvant therapy. These variables were considered in subsequent adjusted analyses. Table 1 Baseline characteristics before propensity score matching Variable SP-RARP (n = 45) MP-RARP (n = 45) P value |SMD| Age, years 68.00 (62.00–74.00) 71.00 (67.00–75.00) 0.241 0.193 BMI, kg/m² 24.09 (22.10-25.26) 23.15 (21.15–25.51) 0.184 0.321 Preoperative PSA, ng/mL 11.85 (7.95-15.00) 16.70 (11.31–51.60) 0.018 0.056 PSA > 20 ng/mL 9 (20.0) 18 (40.0) 0.065 0.436 MRI prostate volume, mL 27.73 (19.73–39.09) 37.00 (28.40-53.01) 0.006 0.628 Preoperative HGB, g/L 141.00 (132.00-150.00) 138.00 (127.00-143.00) 0.091 0.388 Neoadjuvant therapy 6 (13.3) 14 (31.1) 0.074 0.428 Biopsy GG5 11 (24.4) 13 (28.9) 0.812 0.101 Values are median (IQR) or n (%). SMD, standardized mean difference; HGB, hemoglobin; PSA, prostate-specific antigen. Table 2 Baseline characteristics after propensity score matching Variable SP-RARP (n = 35) MP-RARP (n = 35) P value |SMD| Age, years 68.00 (62.50–74.00) 71.00 (63.50–75.00) 0.672 0.025 BMI, kg/m² 23.74 (21.77–25.12) 23.53 (22.09–25.73) 0.991 0.012 Preoperative PSA, ng/mL 12.24 (8.19–14.74) 13.79 (10.90-36.75) 0.122 0.031 PSA > 20 ng/mL 7 (20.0) 12 (34.3) 0.282 0.321 MRI prostate volume, mL 28.70 (21.96–39.87) 36.30 (28.29–47.95) 0.073 0.439 Preoperative HGB, g/L 140.00 (132.00-150.50) 138.00 (129.50-145.50) 0.470 0.245 Neoadjuvant therapy 6 (17.1) 12 (34.3) 0.171 0.392 Biopsy GG5 10 (28.6) 11 (31.4) 1.000 0.062 Values are median (IQR) or n (%). SMD, standardized mean difference; HGB, hemoglobin; PSA, prostate-specific antigen. 3.3 Perioperative outcomes Perioperative outcomes after matching are shown in Table 3 . The median operative time was 133.00 (120.00-151.50) minutes in the SP-RARP group and 115.00 (101.50–157.00) minutes in the MP-RARP group. The difference was not statistically significant (P = 0.324). The median hemoglobin decrease was 18.00 (14.00–31.00) g/L and 20.50 (13.25-24.00) g/L, respectively (P = 0.331). The median percentage decrease in hemoglobin was 13.64% (9.62%-20.45%) and 14.70% (10.16%-17.08%), respectively (P = 0.380). The median postoperative hospital stay was 4.00 days in both groups. The values were 4.00 (4.00–4.00) days in the SP-RARP group and 4.00 (4.00–5.00) days in the MP-RARP group (P = 0.363). Overall, no significant differences were observed in operative time, hemoglobin decrease, percentage hemoglobin decrease, or postoperative hospital stay. Table 3 Perioperative outcomes after propensity score matching Variable SP-RARP (n = 35) MP-RARP (n = 35) P value Operative time, min 133.00 (120.00-151.50) 115.00 (101.50–157.00) 0.324 HGB decrease, g/L 18.00 (14.00–31.00) 20.50 (13.25-24.00) 0.331 HGB decrease, % 13.64 (9.62–20.45) 14.70 (10.16–17.08) 0.380 Postoperative hospital stay, days 4.00 (4.00–4.00) 4.00 (4.00–5.00) 0.363 Values are median (IQR). HGB decrease was calculated as preoperative HGB minus postoperative HGB. HGB decrease percentage was calculated as HGB decrease/preoperative HGB x 100%. 3.4 Pathological outcomes Pathological outcomes after matching are shown in Table 4 . The distribution of pathological Grade Group did not differ significantly between the two groups (P = 0.751). In the SP-RARP group, Grade Groups 2, 3, 4, and 5 were observed in 3 (9.7%), 10 (32.3%), 8 (25.8%), and 10 (32.3%) patients, respectively. In the MP-RARP group, the corresponding values were 4 (12.5%), 11 (34.4%), 5 (15.6%), and 11 (34.4%). The median pathological prostate volume was 37.32 (26.66–44.68) mL in the SP-RARP group and 35.60 (27.00-44.83) mL in the MP-RARP group (P = 0.972). Positive surgical margins were observed in 48.6% and 54.3% of patients, respectively (P = 0.811). Extraprostatic extension was present in 47.1% and 32.3% of patients (P = 0.311). Seminal vesicle invasion was present in 17.1% and 14.3% of patients (P = 1.000). Lymphovascular invasion was present in 11.4% and 14.3% of patients (P = 1.000). Perineural invasion was present in 85.7% and 82.9% of patients (P = 1.000). pT3 or above was observed in 40.0% and 41.2% of patients, respectively (P = 1.000). Pelvic lymph node dissection was performed in 40.0% of SP-RARP patients and 51.4% of MP-RARP patients (P = 0.472). Among patients who underwent pelvic lymph node dissection, the median number of lymph nodes removed was 10.50 (7.25-11.00) and 9.00 (8.00-10.75), respectively (P = 0.760). The median number of positive lymph nodes was 0.00 (0.00–0.00) in both groups (P = 0.467). Lymph node positivity was observed in 1 of 14 patients (7.1%) in the SP-RARP group and 3 of 18 patients (16.7%) in the MP-RARP group (P = 0.613). Overall, SP-RARP was not associated with higher rates of positive surgical margin or lymph node positivity. Table 4 Pathological outcomes after propensity score matching Variable SP-RARP (n = 35) MP-RARP (n = 35) P value Pathological Grade Group 0.751 Grade Group 2 3 (9.7) 4 (12.5) Grade Group 3 10 (32.3) 11 (34.4) Grade Group 4 8 (25.8) 5 (15.6) Grade Group 5 10 (32.3) 11 (34.4) Pathological prostate volume, mL 37.32 (26.66–44.68) 35.60 (27.00-44.83) 0.972 Positive surgical margin 17 (48.6) 19 (54.3) 0.811 Extraprostatic extension 16 (47.1) 10 (32.3) 0.311 Seminal vesicle invasion 6 (17.1) 5 (14.3) 1.000 Lymphovascular invasion 4 (11.4) 5 (14.3) 1.000 Perineural invasion 30 (85.7) 29 (82.9) 1.000 pT3 or above 14 (40.0) 14 (41.2) 1.000 Pelvic lymph node dissection 14 (40.0) 18 (51.4) 0.472 pN1† 1 (7.1) 3 (16.7) 0.613 Total lymph nodes removed† 10.50 (7.25-11.00) 9.00 (8.00-10.75) 0.760 Positive lymph nodes† 0.00 (0.00–0.00) 0.00 (0.00–0.00) 0.467 Lymph node positive† 1 (7.1) 3 (16.7) 0.613 Values are median (IQR) or n (%). †Calculated among patients who underwent pelvic lymph node dissection. 3.5 Early PSA outcomes Early PSA outcomes after matching are shown in Table 5 . Early PSA data were available for 17 patients (48.6%) in the SP-RARP group and 16 patients (45.7%) in the MP-RARP group (P = 1.000). The median early PSA level was 0.013 (0.010–0.040) ng/mL and 0.016 (0.010–0.054) ng/mL, respectively (P = 0.610). Using different PSA thresholds, PSA > = 0.01 ng/mL was observed in 76.5% and 87.5% of patients (P = 0.656). PSA > = 0.03 ng/mL was observed in 29.4% and 31.2% of patients (P = 1.000). PSA > = 0.10 ng/mL was observed in 5.9% and 18.8% of patients (P = 0.335). PSA > = 0.20 ng/mL was observed in 5.9% and 12.5% of patients (P = 0.601). These results suggest similar early PSA clearance between the two groups. Table 5 Early PSA outcomes after propensity score matching Variable SP-RARP (n = 35) MP-RARP (n = 35) P value Available early PSA data 17 (48.6) 16 (45.7) 1.000 Early PSA, ng/mL 0.013 (0.010–0.040) 0.016 (0.010–0.054) 0.610 PSA > = 0.01 ng/mL 13 (76.5) 14 (87.5) 0.656 PSA > = 0.03 ng/mL 5 (29.4) 5 (31.2) 1.000 PSA > = 0.10 ng/mL 1 (5.9) 3 (18.8) 0.335 PSA > = 0.20 ng/mL 1 (5.9) 2 (12.5) 0.601 Values are median (IQR) or n (%). Early PSA refers to PSA measured approximately 1 month after surgery when available. 3.6 Adjusted and sensitivity analyses Because residual differences remained in MRI-measured prostate volume and some tumor-related baseline variables after matching, multivariable adjusted analyses were performed. The models were adjusted for log10 preoperative PSA, MRI-measured prostate volume, biopsy Grade Group 5, and neoadjuvant therapy. Hypertension and diabetes mellitus were not included in the adjusted models. Continuous outcomes were analyzed using linear regression. Binary outcomes were analyzed using logistic regression. The adjusted results are shown in Table 6 . SP-RARP was not significantly associated with operative time (beta = 9.21, 95% CI -10.59 to 29.02, P = 0.362). It was also not associated with hemoglobin decrease (beta = 4.01, 95% CI -1.62 to 9.64, P = 0.162) or percentage hemoglobin decrease (beta = 2.36, 95% CI -1.28 to 6.01, P = 0.203). SP-RARP was not associated with postoperative hospital stay (beta=-0.13, 95% CI -0.47 to 0.20, P = 0.433). For binary outcomes, SP-RARP was not associated with positive surgical margin (OR = 0.80, 95% CI 0.28 to 2.29, P = 0.684). In the exploratory model, SP-RARP was not associated with early PSA > = 0.03 ng/mL (OR = 0.80, 95% CI 0.15 to 4.31, P = 0.792). Table 6 Adjusted analysis / sensitivity analysis after propensity score matching Outcome Model N Effect Estimate 95% CI P value Operative time, min Linear regression 70 beta 9.21 -10.59 to 29.02 0.362 HGB decrease, g/L Linear regression 67 beta 4.01 -1.62 to 9.64 0.162 HGB decrease, % Linear regression 67 beta 2.36 -1.28 to 6.01 0.203 Postoperative hospital stay, days Linear regression 70 beta -0.13 -0.47 to 0.20 0.433 Positive surgical margin Logistic regression 70 OR 0.80 0.28 to 2.29 0.684 Early PSA > = 0.03 ng/mL Exploratory logistic regression 33 OR 0.80 0.15 to 4.31 0.792 Values are adjusted estimates and 95% confidence intervals. Continuous outcomes were analyzed using linear regression. Binary outcomes were analyzed using logistic regression. The adjusted models included log10 preoperative PSA, MRI prostate volume, biopsy Grade Group 5, and neoadjuvant therapy. Discussion This study compared short-term outcomes between SP-RARP and MP-RARP in patients with high-risk prostate cancer. The main findings were as follows. First, after 1:1 matching, the two groups were generally comparable in age, BMI, preoperative PSA, and biopsy Grade Group. Second, no significant differences were found in operative time, hemoglobin decrease, percentage hemoglobin decrease, postoperative hospital stay, positive surgical margin, pelvic lymph node dissection outcomes, or early PSA outcomes. Third, after adjustment for log10 preoperative PSA, MRI-measured prostate volume, biopsy Grade Group 5, and neoadjuvant therapy, SP-RARP was not associated with a higher risk of positive surgical margin or early PSA > = 0.03 ng/mL. Overall, SP-RARP using the EDGE SP1000 platform achieved short-term perioperative, pathological, and early PSA outcomes comparable to those of MP-RARP in this high-risk cohort. Previous comparisons of SP-RARP and MP-RARP have mainly focused on general prostate cancer populations rather than high-risk patients. A meta-analysis by Nguyen et al. compared perioperative, oncological, and functional outcomes between SP-RARP and MP-RARP. It suggested that SP-RARP may offer some recovery benefits, while oncological and functional outcomes were broadly similar [ 16 ]. Fahmy et al. also reported shorter hospital stay and lower analgesic requirements with single-port surgery [ 23 ]. Our study differs from these reports in two ways. It focused on high-risk prostate cancer and it compared the EDGE SP1000 platform with the da Vinci Xi multiport system. In high-risk disease, assessment of surgical approach should not focus only on incision number or early recovery. It should also consider margin status, lymph node findings and postoperative PSA clearance. In this study, operative time, hemoglobin decrease, and percentage hemoglobin decrease were similar between groups. These findings suggest that SP-RARP did not increase operative duration or perioperative blood loss-related burden. Surgery in high-risk prostate cancer is often more complex than surgery in low- or intermediate-risk disease. Local extension, risk of seminal vesicle invasion, and the need for pelvic lymph node dissection may increase technical difficulty [ 22 , 24 ]. The comparable operative and hemoglobin outcomes in this cohort support the feasibility of SP-RARP in experienced doctors. The postoperative hospital stay was not shorter in the SP-RARP group. This finding differs from some previous reports showing shorter hospitalization after single-port surgery. Several factors may explain this difference. First, our cohort included only high-risk patients, whereas many previous studies included mixed-risk populations. High-risk patients may require closer postoperative observation. Second, the EDGE SP1000 platform was still being integrated into clinical workflow during the study period. The learning curve, nursing protocols, drain management and discharge criteria may have affected hospital stay. Third, hospital stay may also reflect non-medical factors, including patient preference and local practice patterns. Pathological oncological safety is central in high-risk prostate cancer surgery. In this study, positive surgical margin and lymph node yield were not significantly different between groups. Adjusted analysis also showed no association between SP-RARP and positive surgical margin or early PSA > = 0.03 ng/mL. These results suggest that SP-RARP was not inferior to MP-RARP in short-term pathological safety. In high-risk prostate cancer, positive surgical margin and lymph node positivity may influence the need for adjuvant or salvage treatment. The value of this study is not to show long-term oncological superiority. Rather, it provides early evidence that SP-RARP did not worsen short-term pathological outcomes in high-risk patients. This study used propensity score matching to reduce selection bias. After matching, SMD was used to assess balance. SMD is commonly used to evaluate covariate balance after propensity score matching. It is more informative than relying only on P values. In this study, balance improved for age, BMI, preoperative PSA, and biopsy Grade Group 5. MRI-measured prostate volume still showed some residual imbalance. We therefore adjusted for MRI-measured prostate volume, log10 preoperative PSA, biopsy Grade Group 5, and neoadjuvant therapy in multivariable models. The adjusted results were consistent with the unadjusted comparisons. This study has clinical relevance. Most previous studies of SP-RARP and MP-RARP included mixed-risk patients. High-risk patients have greater demands for surgical quality and oncological control. Our study adds early evidence for the use of a single-port platform in a more complex tumor population. The EDGE SP1000 system also differs from conventional multiport systems in instrument design, working space, arm layout and surgeon handling. For a new platform, the learning curve, case selection, team coordination, and perioperative workflow may affect early outcomes. Our findings suggest that SP-RARP using this platform did not increase operative time, hemoglobin loss or adverse pathological outcomes in this cohort. This study has several limitations. First, it was a single-center, small-sample observational study. After matching, each group included only 35 patients. The statistical power was limited, especially for binary outcomes such as positive surgical margin, pN1, and early PSA positivity. Second, although matching and multivariable adjustment were used, residual imbalance remained in MRI-measured prostate volume. Some potentially important variables were not fully included, such as ASA score, Charlson comorbidity index, tumor location, and phase of the surgeon learning curve. Third, functional outcomes and complications were not systematically collected. These included continence, catheterization time, pain score, analgesic use and Clavien-Dindo complications. Fourth, early PSA data were incomplete and follow-up was short. Long-term biochemical recurrence-free survival, metastasis-free survival and cancer-specific survival could not be assessed. In conclusion, SP-RARP using the EDGE SP1000 platform achieved perioperative, pathological and early PSA outcomes comparable to those of MP-RARP in patients with high-risk prostate cancer. This study provides preliminary clinical evidence for EDGE SP1000 in complex prostate cancer surgery. Declarations Acknowledgements Not applicable. Availability of data and materials All data generated in this study can be requested from the corresponding author, except for patient related privacy data. Funding/Support and role of the sponsor: This work was supported by the Key Scientific Research Foundation of the Education Department of Anhui Province (2022AH051172) and Health Research Program of Anhui（AHWJ2024Aa40005, AHWJ2024BAc20030, AHWJ2024Aa30053). Ethics approval and consent to participate All the procedures were approved by the Medical Ethical Committees of First Affiliated Hospital of Anhui Medical University (No. PJ 2025-2-81). This study strictly adheres to the ethical guidelines of Declaration of Helsinki, ensuring that the rights of all participants are fully protected. Author contributions Hongzhi Wang contributed to the conception and design of the study, data analysis, interpretation of the results and drafting of the manuscript. Weiqi Zhao and Jialong Zhang collected and organized the clinical data. Sheng Tai and Chaozhao Liang were the principal surgeons for the procedures, contributed to the study design, provided methodological guidance, supervised the study, and critically reviewed and revised the manuscript. All authors read and approved the final manuscript. Competing interests The authors declare no competing interests. References Reitano G et al (2024) Treatment and Staging Intensification Strategies Associated with Radical Prostatectomy for High-Risk Prostate Cancer: Efficacy Evaluation and Exploration of Novel Approaches. Cancers 16:2465. 10.3390/cancers16132465 Reina Y, Villaquirán C, García-Perdomo HA (2023) Advances in high-risk localized prostate cancer: Staging and management. Curr Probl Cancer 47(4):100993 Devos G, Chapple CR, Wein AJ et al (2025) Springer Nature Switzerland: Cham. 93–110 Shore ND et al (2024) Biochemical recurrence in patients with prostate cancer after primary definitive therapy: treatment based on risk stratification. 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PLoS ONE 19(7):e0301653 Wu S et al (2023) Clinicopathological and oncological significance of persistent prostate-specific antigen after radical prostatectomy: A systematic review and meta-analysis. Asian J Urol 10(3):317–328 Wang J et al (2023) Robot-assisted versus open radical prostatectomy: a systematic review and meta-analysis of prospective studies. J Robot Surg 17(6):2617–2631 Kulthe Ramesh SB et al (2026) Current Surgical Treatment of Prostate Cancer. Urologic Clin 53(1):135–152 Ali SN et al (2024) Feasibility and Outcomes of Same-Day Discharge after Multiport Robot-Assisted Radical Prostatectomy. J Endourol 38(12):1346–1352 Franco A et al (2025) Single port robot-assisted radical and simple prostatectomy: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 28(1):117–128 Checcucci E et al (2020) Single-port robot-assisted radical prostatectomy: a systematic review and pooled analysis of the preliminary experiences. BJU Int 126(1):55–64 Nguyen TT et al (2023) Single-port and multiport robot-assisted radical prostatectomy: A meta-analysis. Prostate Int 11(4):187–194 Li K et al (2022) Perioperative and Oncologic Outcomes of Single-Port vs Multiport Robot-Assisted Radical Prostatectomy: A Meta-Analysis. J Endourol 36(1):83–98 Chierigo F et al (2026) Outcomes of robot-assisted radical prostatectomy with novel robotic platforms vs da Vinci multiport systems: a systematic review and network meta-analysis. Prostate Cancer Prostatic Dis 29(1):57–72 Xiao X et al (2025) Perioperative efficiency and clinical outcomes of single-port versus multi-port robot-assisted radical prostatectomy: an updated meta-analysis. J Robot Surg 19(1):492 Fernandez-Mateos J et al (2024) Tumor evolution metrics predict recurrence beyond 10 years in locally advanced prostate cancer. Nat Cancer 5(9):1334–1351 Klingenberg S et al (2021) (68)Ga-PSMA PET/CT for Primary Lymph Node and Distant Metastasis NM Staging of High-Risk Prostate Cancer. J Nucl Med 62(2):214–220 Małkiewicz B et al (2021) External Validation of the Briganti Nomogram to Predict Lymph Node Invasion in Prostate Cancer-Setting a New Threshold Value. Life (Basel), 11(6) Fahmy O et al (2021) Single-Port versus Multiple-Port Robot-Assisted Radical Prostatectomy: A Systematic Review and Meta-Analysis. J Clin Med, 10(24) Greenberg SA, Nguyen HG, Carroll PR et al (2022) Management of Extracapsular Extension and Positive Surgical Margins Following Robot-Assisted, Laparoscopic Radical Prostatectomy, in Robotic Urologic Surgery, P. Wiklund, Editors. Springer International Publishing: Cham. pp. 373–384 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9613058","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":635272622,"identity":"b9c26e30-b85c-4d84-8e00-ef366577ca06","order_by":0,"name":"Hongzhi Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9ElEQVRIiWNgGAWjYJACZjApwdj4gLEBzDQgWkuzAalaGNgkiNJicPzs4dcFFXfs5s9ubqv4uWNbYgN78zYJhpo7uLWcyUuznnHmWXLjnINtN3vP3E5s4DlWJsFw7BlOLWYHcsyMedsOJzNLJLbd4G0DapHIMQO68DBuLeffQLSwAbUU/gVpkX9DQMuNHOPHQC12PEAtzBBbePBrsb/xxoyZ58zhBAmJxGZp2bbbxm08acUWCcdwa5HszzH+zFNx2F5+RvrDj2/bbsv2sx/eeONDDW4tQMAmASQSG+BcEJGATwMwJj+AHIhfzSgYBaNgFIxoAACS8FqbOmde5wAAAABJRU5ErkJggg==","orcid":"","institution":"First Affiliated Hospital of Anhui Medical University","correspondingAuthor":true,"prefix":"","firstName":"Hongzhi","middleName":"","lastName":"Wang","suffix":""},{"id":635272623,"identity":"646f569e-7a5c-452b-a3d3-9cfa7fc15e35","order_by":1,"name":"Weiqi Zhao","email":"","orcid":"","institution":"Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Weiqi","middleName":"","lastName":"Zhao","suffix":""},{"id":635272624,"identity":"fa69dbe5-ccfa-415e-a2b8-1abd3e91e1ee","order_by":2,"name":"Jialong Zhang","email":"","orcid":"","institution":"First Affiliated Hospital of Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jialong","middleName":"","lastName":"Zhang","suffix":""},{"id":635272625,"identity":"a8657e12-99d5-4cb5-85ad-a15a3e8f2fdb","order_by":3,"name":"Sheng Tai","email":"","orcid":"","institution":"First Affiliated Hospital of Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Sheng","middleName":"","lastName":"Tai","suffix":""},{"id":635272626,"identity":"fad40fb4-03f8-4807-a00e-ec35401e2bbb","order_by":4,"name":"Chaozhao Liang","email":"","orcid":"","institution":"First Affiliated Hospital of Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Chaozhao","middleName":"","lastName":"Liang","suffix":""}],"badges":[],"createdAt":"2026-05-05 02:38:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9613058/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9613058/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109206397,"identity":"ac497512-41f0-4fd4-87b1-e52e407c8d2c","added_by":"auto","created_at":"2026-05-13 15:12:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":261666,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9613058/v1/1bed9572-4cde-45e6-a591-08a149228c90.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of perioperative and short-term oncological outcomes between single-port and multiport robot-assisted radical prostatectomy for high-risk prostate cancer","fulltext":[{"header":"Introduction","content":"\u003cp\u003eProstate cancer is one of the most common malignancies in men. Treatment decisions are challenging for patients with high-risk localized or locally advanced disease. These patients have higher risks of local invasion, lymph node metastasis, biochemical recurrence, and disease progression [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Current guidelines support radical prostatectomy as an important local treatment option in selected patients [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Pelvic lymph node dissection is often considered [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In this setting, surgery should provide acceptable perioperative safety [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. It should also preserve oncological quality, including margin status, pathological stage, and postoperative PSA clearance [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRobot-assisted radical prostatectomy has been widely used for prostate cancer [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Multiport robot-assisted radical prostatectomy (MP-RARP) is a mature technique and remains one of the main surgical approaches [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. With the development of single-port platforms, single-port robot-assisted radical prostatectomy (SP-RARP) has entered clinical practice [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Previous studies in mixed-risk prostate cancer cohorts suggest that SP-RARP may reduce postoperative pain, hospital stay, and catheterization time. Early functional and oncological outcomes appear comparable to those of MP-RARP [\u003cspan additionalcitationids=\"CR17 CR18\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, most comparisons between SP-RARP and MP-RARP have included mixed-risk populations [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Evidence specific to high-risk prostate cancer remains limited. High-risk patients differ from low- and intermediate-risk patients in tumor biology, local extent, lymph node risk, and the need for lymph node dissection [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Findings from general prostate cancer cohorts may not apply directly to this group. It remains unclear whether the potential perioperative benefits of SP-RARP can be achieved without compromising pathological or early oncological outcomes.\u003c/p\u003e \u003cp\u003eThis study compared perioperative, pathological, and early oncological outcomes between SP-RARP and MP-RARP in patients with high-risk prostate cancer. The aim was to provide clinical evidence for surgical decision-making in this high-risk population.\u003c/p\u003e"},{"header":"Patients and methods","content":"\u003cp\u003eThis was a single-center cohort study conducted at the First Affiliated Hospital of Anhui Medical University. The study was approved by the institutional ethics committee (PJ 2025-02-81). Patients with high-risk prostate cancer who underwent robot-assisted radical prostatectomy (RARP) between March 2025 and April 2026 were included. Patients were grouped according to the surgical platform. The SP-RARP group underwent surgery using the EDGE SP1000 single-port robotic system. The MP-RARP group underwent surgery using the da Vinci Xi multiport robotic system. All operations were performed by two experienced surgeons from the same surgical team.\u003c/p\u003e \u003cp\u003eThe inclusion criteria were as follows: histologically confirmed prostate adenocarcinoma; high-risk localized or locally advanced prostate cancer; eligibility for radical prostatectomy after preoperative evaluation; clinical stage cT1-T3aN1M0; life expectancy greater than 10 years; and written informed consent for surgery and study participation. High-risk prostate cancer was defined according to major international risk stratification systems. Patients were considered high risk if they had any of the following: preoperative PSA\u0026thinsp;\u0026gt;\u0026thinsp;20 ng/mL, biopsy Grade Group 4\u0026ndash;5 or Gleason score 8\u0026ndash;10, or clinical stage\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;cT3. The exclusion criteria were distant metastasis on preoperative imaging, a history of major pelvic surgery or pelvic radiotherapy.\u003c/p\u003e \u003cp\u003eAll patients underwent preoperative serum prostate-specific antigen testing, prostate magnetic resonance imaging (MRI), prostate biopsy, and staging examinations when indicated. Baseline data included age, weight, height, body mass index (BMI), preoperative PSA, biopsy Gleason score or Grade Group, MRI-measured prostate volume, clinical stage and imaging stage. In patients scheduled for pelvic lymph node dissection, the extent of dissection and pathological nodal results were also recorded.\u003c/p\u003e \u003cp\u003eAll patients underwent RARP under general anesthesia. The EDGE SP1000 group was treated using the single-port robotic platform. The da Vinci Xi group was treated using the standard multiport platform. Both procedures followed the principles of radical prostatectomy. Pelvic lymph node dissection was performed according to preoperative tumor features and intraoperative findings. In the EDGE SP1000 group, an extraperitoneal approach was used. A midline incision of about 4 cm was made between the umbilicus and the pubic symphysis. After creation of the extraperitoneal space, a multichannel single-port device was inserted. When needed, a 12-mm assistant trocar was placed in the right lower abdomen for suction, clipping, suture transfer, and specimen handling. A pelvic drain was placed at the end of the procedure according to intraoperative findings. The da Vinci Xi group underwent surgery with the standard multiport approach and port layout used at our center.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Study endpoints\u003c/h2\u003e \u003cp\u003eThe main outcomes were perioperative, pathological, and early follow-up outcomes. The primary endpoints included operative time, postoperative hemoglobin decrease, postoperative hospital stay, positive surgical margin, number of lymph nodes removed, number of positive lymph nodes, and PSA level at approximately 1 month after surgery.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Statistical analysis\u003c/h2\u003e \u003cp\u003eContinuous variables were reported as mean +/- standard deviation or median (interquartile range), depending on distribution. Between-group comparisons used the independent-samples t test or the Mann-Whitney U test. Categorical variables were reported as numbers and percentages. Between-group comparisons used the chi-square test or Fisher exact test. Propensity score matching and multivariable regression were used to reduce selection bias and confounding. The propensity score model included age, BMI, log10 preoperative PSA, MRI-measured prostate volume, preoperative hemoglobin, biopsy Grade Group 5, and neoadjuvant therapy. Covariate balance after matching was assessed using the standardized mean difference (SMD). Multivariable models were adjusted for log10 preoperative PSA, MRI-measured prostate volume, biopsy Grade Group 5, and neoadjuvant therapy. All tests were two-sided. A P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Patient inclusion and propensity score matching\u003c/h2\u003e \u003cp\u003eA total of 90 patients with high-risk prostate cancer who underwent RARP were included. There were 45 patients in the SP-RARP group and 45 patients in the MP-RARP group. To reduce baseline imbalance, 1:1 propensity score matching was performed using preoperative variables. The matching variables included age, BMI, log10 preoperative PSA, MRI-measured prostate volume, preoperative hemoglobin, biopsy Grade Group 5, and neoadjuvant therapy. Hypertension and diabetes mellitus were not included in the matching model. After matching, 35 SP-RARP patients and 35 MP-RARP patients were included in the main analysis. Covariate balance was evaluated using the SMD.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Baseline characteristics before and after matching\u003c/h2\u003e \u003cp\u003eBaseline characteristics before matching are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Compared with the SP-RARP group, the MP-RARP group had higher preoperative PSA levels, a higher proportion of PSA\u0026thinsp;\u0026gt;\u0026thinsp;20 ng/mL, larger MRI-measured prostate volume and a higher rate of neoadjuvant therapy. These findings indicated baseline imbalance in the original cohort. After 1:1 propensity score matching, most key baseline variables were generally comparable between the two groups (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The median age was 68.00 (62.50\u0026ndash;74.00) years in the SP-RARP group and 71.00 (63.50\u0026ndash;75.00) years in the MP-RARP group (P\u0026thinsp;=\u0026thinsp;0.672). The median BMI was 23.74 (21.77\u0026ndash;25.12) kg/m\u0026sup2; and 23.53 (22.09\u0026ndash;25.73) kg/m\u0026sup2;, respectively (P\u0026thinsp;=\u0026thinsp;0.991). The median preoperative PSA was 12.24 (8.19\u0026ndash;14.74) ng/mL and 13.79 (10.90-36.75) ng/mL, respectively (P\u0026thinsp;=\u0026thinsp;0.122). PSA\u0026thinsp;\u0026gt;\u0026thinsp;20 ng/mL was present in 20.0% and 34.3% of patients, respectively (P\u0026thinsp;=\u0026thinsp;0.282). Biopsy Grade Group 5 was present in 28.6% and 31.4% of patients, respectively (P\u0026thinsp;=\u0026thinsp;1.000).\u003c/p\u003e \u003cp\u003eThe SMD analysis showed improved balance for age, BMI, preoperative PSA, and biopsy Grade Group 5 after matching. Residual differences remained for MRI-measured prostate volume, preoperative hemoglobin, PSA\u0026thinsp;\u0026gt;\u0026thinsp;20 ng/mL, and neoadjuvant therapy. These variables were considered in subsequent adjusted analyses.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics before propensity score matching\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSP-RARP (n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMP-RARP (n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e|SMD|\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e68.00 (62.00\u0026ndash;74.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71.00 (67.00\u0026ndash;75.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.241\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.193\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, kg/m\u0026sup2;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24.09 (22.10-25.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.15 (21.15\u0026ndash;25.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.321\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative PSA, ng/mL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11.85 (7.95-15.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.70 (11.31\u0026ndash;51.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSA\u0026thinsp;\u0026gt;\u0026thinsp;20 ng/mL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18 (40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.436\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMRI prostate volume, mL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27.73 (19.73\u0026ndash;39.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37.00 (28.40-53.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.628\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative HGB, g/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e141.00 (132.00-150.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e138.00 (127.00-143.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.091\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.388\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeoadjuvant therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (31.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.428\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBiopsy GG5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11 (24.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (28.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.812\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eValues are median (IQR) or n (%). SMD, standardized mean difference; HGB, hemoglobin; PSA, prostate-specific antigen.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics after propensity score matching\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSP-RARP (n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMP-RARP (n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e|SMD|\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e68.00 (62.50\u0026ndash;74.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71.00 (63.50\u0026ndash;75.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.672\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, kg/m\u0026sup2;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23.74 (21.77\u0026ndash;25.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.53 (22.09\u0026ndash;25.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.991\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative PSA, ng/mL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12.24 (8.19\u0026ndash;14.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.79 (10.90-36.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSA\u0026thinsp;\u0026gt;\u0026thinsp;20 ng/mL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (34.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.282\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.321\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMRI prostate volume, mL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28.70 (21.96\u0026ndash;39.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36.30 (28.29\u0026ndash;47.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.073\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.439\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative HGB, g/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e140.00 (132.00-150.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e138.00 (129.50-145.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.470\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.245\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeoadjuvant therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (17.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (34.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.392\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBiopsy GG5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (31.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eValues are median (IQR) or n (%). SMD, standardized mean difference; HGB, hemoglobin; PSA, prostate-specific antigen.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Perioperative outcomes\u003c/h2\u003e \u003cp\u003ePerioperative outcomes after matching are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The median operative time was 133.00 (120.00-151.50) minutes in the SP-RARP group and 115.00 (101.50\u0026ndash;157.00) minutes in the MP-RARP group. The difference was not statistically significant (P\u0026thinsp;=\u0026thinsp;0.324). The median hemoglobin decrease was 18.00 (14.00\u0026ndash;31.00) g/L and 20.50 (13.25-24.00) g/L, respectively (P\u0026thinsp;=\u0026thinsp;0.331). The median percentage decrease in hemoglobin was 13.64% (9.62%-20.45%) and 14.70% (10.16%-17.08%), respectively (P\u0026thinsp;=\u0026thinsp;0.380).\u003c/p\u003e \u003cp\u003eThe median postoperative hospital stay was 4.00 days in both groups. The values were 4.00 (4.00\u0026ndash;4.00) days in the SP-RARP group and 4.00 (4.00\u0026ndash;5.00) days in the MP-RARP group (P\u0026thinsp;=\u0026thinsp;0.363). Overall, no significant differences were observed in operative time, hemoglobin decrease, percentage hemoglobin decrease, or postoperative hospital stay.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePerioperative outcomes after propensity score matching\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSP-RARP (n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMP-RARP (n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperative time, min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e133.00 (120.00-151.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e115.00 (101.50\u0026ndash;157.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.324\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHGB decrease, g/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.00 (14.00\u0026ndash;31.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.50 (13.25-24.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.331\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHGB decrease, %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.64 (9.62\u0026ndash;20.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.70 (10.16\u0026ndash;17.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.380\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative hospital stay, days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.00 (4.00\u0026ndash;4.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.00 (4.00\u0026ndash;5.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.363\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eValues are median (IQR). HGB decrease was calculated as preoperative HGB minus postoperative HGB. HGB decrease percentage was calculated as HGB decrease/preoperative HGB x 100%.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Pathological outcomes\u003c/h2\u003e \u003cp\u003ePathological outcomes after matching are shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. The distribution of pathological Grade Group did not differ significantly between the two groups (P\u0026thinsp;=\u0026thinsp;0.751). In the SP-RARP group, Grade Groups 2, 3, 4, and 5 were observed in 3 (9.7%), 10 (32.3%), 8 (25.8%), and 10 (32.3%) patients, respectively. In the MP-RARP group, the corresponding values were 4 (12.5%), 11 (34.4%), 5 (15.6%), and 11 (34.4%). The median pathological prostate volume was 37.32 (26.66\u0026ndash;44.68) mL in the SP-RARP group and 35.60 (27.00-44.83) mL in the MP-RARP group (P\u0026thinsp;=\u0026thinsp;0.972).\u003c/p\u003e \u003cp\u003ePositive surgical margins were observed in 48.6% and 54.3% of patients, respectively (P\u0026thinsp;=\u0026thinsp;0.811). Extraprostatic extension was present in 47.1% and 32.3% of patients (P\u0026thinsp;=\u0026thinsp;0.311). Seminal vesicle invasion was present in 17.1% and 14.3% of patients (P\u0026thinsp;=\u0026thinsp;1.000). Lymphovascular invasion was present in 11.4% and 14.3% of patients (P\u0026thinsp;=\u0026thinsp;1.000). Perineural invasion was present in 85.7% and 82.9% of patients (P\u0026thinsp;=\u0026thinsp;1.000). pT3 or above was observed in 40.0% and 41.2% of patients, respectively (P\u0026thinsp;=\u0026thinsp;1.000).\u003c/p\u003e \u003cp\u003ePelvic lymph node dissection was performed in 40.0% of SP-RARP patients and 51.4% of MP-RARP patients (P\u0026thinsp;=\u0026thinsp;0.472). Among patients who underwent pelvic lymph node dissection, the median number of lymph nodes removed was 10.50 (7.25-11.00) and 9.00 (8.00-10.75), respectively (P\u0026thinsp;=\u0026thinsp;0.760). The median number of positive lymph nodes was 0.00 (0.00\u0026ndash;0.00) in both groups (P\u0026thinsp;=\u0026thinsp;0.467). Lymph node positivity was observed in 1 of 14 patients (7.1%) in the SP-RARP group and 3 of 18 patients (16.7%) in the MP-RARP group (P\u0026thinsp;=\u0026thinsp;0.613). Overall, SP-RARP was not associated with higher rates of positive surgical margin or lymph node positivity.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePathological outcomes after propensity score matching\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSP-RARP (n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMP-RARP (n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePathological Grade Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.751\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade Group 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade Group 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (32.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade Group 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (25.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade Group 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (32.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePathological prostate volume, mL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37.32 (26.66\u0026ndash;44.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35.60 (27.00-44.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.972\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive surgical margin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17 (48.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (54.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.811\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtraprostatic extension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16 (47.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (32.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.311\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeminal vesicle invasion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (17.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymphovascular invasion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerineural invasion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30 (85.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29 (82.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epT3 or above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (41.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePelvic lymph node dissection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18 (51.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.472\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epN1\u0026dagger;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.613\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal lymph nodes removed\u0026dagger;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10.50 (7.25-11.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.00 (8.00-10.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.760\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive lymph nodes\u0026dagger;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.00 (0.00\u0026ndash;0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.00 (0.00\u0026ndash;0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.467\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymph node positive\u0026dagger;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.613\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eValues are median (IQR) or n (%). \u0026dagger;Calculated among patients who underwent pelvic lymph node dissection.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Early PSA outcomes\u003c/h2\u003e \u003cp\u003eEarly PSA outcomes after matching are shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. Early PSA data were available for 17 patients (48.6%) in the SP-RARP group and 16 patients (45.7%) in the MP-RARP group (P\u0026thinsp;=\u0026thinsp;1.000). The median early PSA level was 0.013 (0.010\u0026ndash;0.040) ng/mL and 0.016 (0.010\u0026ndash;0.054) ng/mL, respectively (P\u0026thinsp;=\u0026thinsp;0.610).\u003c/p\u003e \u003cp\u003eUsing different PSA thresholds, PSA\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;0.01 ng/mL was observed in 76.5% and 87.5% of patients (P\u0026thinsp;=\u0026thinsp;0.656). PSA\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;0.03 ng/mL was observed in 29.4% and 31.2% of patients (P\u0026thinsp;=\u0026thinsp;1.000). PSA\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;0.10 ng/mL was observed in 5.9% and 18.8% of patients (P\u0026thinsp;=\u0026thinsp;0.335). PSA\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;0.20 ng/mL was observed in 5.9% and 12.5% of patients (P\u0026thinsp;=\u0026thinsp;0.601). These results suggest similar early PSA clearance between the two groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEarly PSA outcomes after propensity score matching\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSP-RARP (n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMP-RARP (n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAvailable early PSA data\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17 (48.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16 (45.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEarly PSA, ng/mL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.013 (0.010\u0026ndash;0.040)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.016 (0.010\u0026ndash;0.054)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.610\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSA\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;0.01 ng/mL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (76.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (87.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.656\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSA\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;0.03 ng/mL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (29.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (31.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSA\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;0.10 ng/mL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (18.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.335\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSA\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;0.20 ng/mL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.601\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eValues are median (IQR) or n (%). Early PSA refers to PSA measured approximately 1 month after surgery when available.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.6 Adjusted and sensitivity analyses\u003c/h2\u003e \u003cp\u003eBecause residual differences remained in MRI-measured prostate volume and some tumor-related baseline variables after matching, multivariable adjusted analyses were performed. The models were adjusted for log10 preoperative PSA, MRI-measured prostate volume, biopsy Grade Group 5, and neoadjuvant therapy. Hypertension and diabetes mellitus were not included in the adjusted models. Continuous outcomes were analyzed using linear regression. Binary outcomes were analyzed using logistic regression.\u003c/p\u003e \u003cp\u003eThe adjusted results are shown in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e. SP-RARP was not significantly associated with operative time (beta\u0026thinsp;=\u0026thinsp;9.21, 95% CI -10.59 to 29.02, P\u0026thinsp;=\u0026thinsp;0.362). It was also not associated with hemoglobin decrease (beta\u0026thinsp;=\u0026thinsp;4.01, 95% CI -1.62 to 9.64, P\u0026thinsp;=\u0026thinsp;0.162) or percentage hemoglobin decrease (beta\u0026thinsp;=\u0026thinsp;2.36, 95% CI -1.28 to 6.01, P\u0026thinsp;=\u0026thinsp;0.203). SP-RARP was not associated with postoperative hospital stay (beta=-0.13, 95% CI -0.47 to 0.20, P\u0026thinsp;=\u0026thinsp;0.433). For binary outcomes, SP-RARP was not associated with positive surgical margin (OR\u0026thinsp;=\u0026thinsp;0.80, 95% CI 0.28 to 2.29, P\u0026thinsp;=\u0026thinsp;0.684). In the exploratory model, SP-RARP was not associated with early PSA\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;0.03 ng/mL (OR\u0026thinsp;=\u0026thinsp;0.80, 95% CI 0.15 to 4.31, P\u0026thinsp;=\u0026thinsp;0.792).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAdjusted analysis / sensitivity analysis after propensity score matching\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEffect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEstimate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperative time, min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLinear regression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ebeta\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-10.59 to 29.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.362\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHGB decrease, g/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLinear regression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ebeta\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.62 to 9.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.162\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHGB decrease, %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLinear regression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ebeta\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.28 to 6.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.203\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative hospital stay, days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLinear regression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ebeta\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.47 to 0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.433\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive surgical margin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLogistic regression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.28 to 2.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.684\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEarly PSA\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;0.03 ng/mL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExploratory logistic regression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.15 to 4.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.792\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eValues are adjusted estimates and 95% confidence intervals. Continuous outcomes were analyzed using linear regression. Binary outcomes were analyzed using logistic regression. The adjusted models included log10 preoperative PSA, MRI prostate volume, biopsy Grade Group 5, and neoadjuvant therapy.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study compared short-term outcomes between SP-RARP and MP-RARP in patients with high-risk prostate cancer. The main findings were as follows. First, after 1:1 matching, the two groups were generally comparable in age, BMI, preoperative PSA, and biopsy Grade Group. Second, no significant differences were found in operative time, hemoglobin decrease, percentage hemoglobin decrease, postoperative hospital stay, positive surgical margin, pelvic lymph node dissection outcomes, or early PSA outcomes. Third, after adjustment for log10 preoperative PSA, MRI-measured prostate volume, biopsy Grade Group 5, and neoadjuvant therapy, SP-RARP was not associated with a higher risk of positive surgical margin or early PSA\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;0.03 ng/mL. Overall, SP-RARP using the EDGE SP1000 platform achieved short-term perioperative, pathological, and early PSA outcomes comparable to those of MP-RARP in this high-risk cohort.\u003c/p\u003e \u003cp\u003ePrevious comparisons of SP-RARP and MP-RARP have mainly focused on general prostate cancer populations rather than high-risk patients. A meta-analysis by Nguyen et al. compared perioperative, oncological, and functional outcomes between SP-RARP and MP-RARP. It suggested that SP-RARP may offer some recovery benefits, while oncological and functional outcomes were broadly similar [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Fahmy et al. also reported shorter hospital stay and lower analgesic requirements with single-port surgery [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Our study differs from these reports in two ways. It focused on high-risk prostate cancer and it compared the EDGE SP1000 platform with the da Vinci Xi multiport system. In high-risk disease, assessment of surgical approach should not focus only on incision number or early recovery. It should also consider margin status, lymph node findings and postoperative PSA clearance.\u003c/p\u003e \u003cp\u003eIn this study, operative time, hemoglobin decrease, and percentage hemoglobin decrease were similar between groups. These findings suggest that SP-RARP did not increase operative duration or perioperative blood loss-related burden. Surgery in high-risk prostate cancer is often more complex than surgery in low- or intermediate-risk disease. Local extension, risk of seminal vesicle invasion, and the need for pelvic lymph node dissection may increase technical difficulty [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The comparable operative and hemoglobin outcomes in this cohort support the feasibility of SP-RARP in experienced doctors.\u003c/p\u003e \u003cp\u003eThe postoperative hospital stay was not shorter in the SP-RARP group. This finding differs from some previous reports showing shorter hospitalization after single-port surgery. Several factors may explain this difference. First, our cohort included only high-risk patients, whereas many previous studies included mixed-risk populations. High-risk patients may require closer postoperative observation. Second, the EDGE SP1000 platform was still being integrated into clinical workflow during the study period. The learning curve, nursing protocols, drain management and discharge criteria may have affected hospital stay. Third, hospital stay may also reflect non-medical factors, including patient preference and local practice patterns.\u003c/p\u003e \u003cp\u003ePathological oncological safety is central in high-risk prostate cancer surgery. In this study, positive surgical margin and lymph node yield were not significantly different between groups. Adjusted analysis also showed no association between SP-RARP and positive surgical margin or early PSA\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;0.03 ng/mL. These results suggest that SP-RARP was not inferior to MP-RARP in short-term pathological safety. In high-risk prostate cancer, positive surgical margin and lymph node positivity may influence the need for adjuvant or salvage treatment. The value of this study is not to show long-term oncological superiority. Rather, it provides early evidence that SP-RARP did not worsen short-term pathological outcomes in high-risk patients.\u003c/p\u003e \u003cp\u003eThis study used propensity score matching to reduce selection bias. After matching, SMD was used to assess balance. SMD is commonly used to evaluate covariate balance after propensity score matching. It is more informative than relying only on P values. In this study, balance improved for age, BMI, preoperative PSA, and biopsy Grade Group 5. MRI-measured prostate volume still showed some residual imbalance. We therefore adjusted for MRI-measured prostate volume, log10 preoperative PSA, biopsy Grade Group 5, and neoadjuvant therapy in multivariable models. The adjusted results were consistent with the unadjusted comparisons.\u003c/p\u003e \u003cp\u003eThis study has clinical relevance. Most previous studies of SP-RARP and MP-RARP included mixed-risk patients. High-risk patients have greater demands for surgical quality and oncological control. Our study adds early evidence for the use of a single-port platform in a more complex tumor population. The EDGE SP1000 system also differs from conventional multiport systems in instrument design, working space, arm layout and surgeon handling. For a new platform, the learning curve, case selection, team coordination, and perioperative workflow may affect early outcomes. Our findings suggest that SP-RARP using this platform did not increase operative time, hemoglobin loss or adverse pathological outcomes in this cohort.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, it was a single-center, small-sample observational study. After matching, each group included only 35 patients. The statistical power was limited, especially for binary outcomes such as positive surgical margin, pN1, and early PSA positivity. Second, although matching and multivariable adjustment were used, residual imbalance remained in MRI-measured prostate volume. Some potentially important variables were not fully included, such as ASA score, Charlson comorbidity index, tumor location, and phase of the surgeon learning curve. Third, functional outcomes and complications were not systematically collected. These included continence, catheterization time, pain score, analgesic use and Clavien-Dindo complications. Fourth, early PSA data were incomplete and follow-up was short. Long-term biochemical recurrence-free survival, metastasis-free survival and cancer-specific survival could not be assessed.\u003c/p\u003e \u003cp\u003eIn conclusion, SP-RARP using the EDGE SP1000 platform achieved perioperative, pathological and early PSA outcomes comparable to those of MP-RARP in patients with high-risk prostate cancer. This study provides preliminary clinical evidence for EDGE SP1000 in complex prostate cancer surgery.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated in this study can be requested from the corresponding author, except for patient related privacy data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding/Support and role of the sponsor:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Key Scientific Research Foundation of the Education Department of Anhui Province (2022AH051172) and Health Research Program of Anhui（AHWJ2024Aa40005, \u0026nbsp;AHWJ2024BAc20030, AHWJ2024Aa30053).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the procedures were approved by the Medical Ethical Committees of First Affiliated Hospital of Anhui Medical University (No. PJ 2025-2-81). This study strictly adheres to the ethical guidelines of Declaration of Helsinki, ensuring that the rights of all participants are fully protected.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHongzhi Wang contributed to the conception and design of the study, data analysis, interpretation of the results and drafting of the manuscript. Weiqi Zhao and Jialong Zhang collected and organized the clinical data. Sheng Tai and Chaozhao Liang were the principal surgeons for the procedures, contributed to the study design, provided methodological guidance, supervised the study, and critically reviewed and revised the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eReitano G et al (2024) Treatment and Staging Intensification Strategies Associated with Radical Prostatectomy for High-Risk Prostate Cancer: Efficacy Evaluation and Exploration of Novel Approaches. Cancers 16:2465. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/cancers16132465\u003c/span\u003e\u003cspan address=\"10.3390/cancers16132465\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReina Y, Villaquir\u0026aacute;n C, Garc\u0026iacute;a-Perdomo HA (2023) Advances in high-risk localized prostate cancer: Staging and management. Curr Probl Cancer 47(4):100993\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDevos G, Chapple CR, Wein AJ et al (2025) Springer Nature Switzerland: Cham. 93\u0026ndash;110\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShore ND et al (2024) Biochemical recurrence in patients with prostate cancer after primary definitive therapy: treatment based on risk stratification. Prostate Cancer Prostatic Dis 27(2):192\u0026ndash;201\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKarsh L et al (2026) Real-world clinical outcomes of patients with localized prostate cancer treated with radical prostatectomy in SEER-Medicare. J Comp Eff Res 15(3):e250004\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFang AM et al (2024) Surgical Management and Considerations for Patients with Localized High-Risk Prostate Cancer. Curr Treat Options Oncol 25(1):66\u0026ndash;83\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSandberg M, Touijer KA (2026) Role of Pelvic Lymph Node Dissection in the Surgical Treatment of Clinically Localized Prostate Cancer. Urol Clin North Am 53(1):153\u0026ndash;164\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAning JJ et al (2019) Perioperative and oncological outcomes of radical prostatectomy for high-risk prostate cancer in the UK: an analysis of surgeon-reported data. BJU Int 124(3):441\u0026ndash;448\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuo H et al (2024) The impact of positive surgical margin parameters and pathological stage on biochemical recurrence after radical prostatectomy: A systematic review and meta-analysis. PLoS ONE 19(7):e0301653\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu S et al (2023) Clinicopathological and oncological significance of persistent prostate-specific antigen after radical prostatectomy: A systematic review and meta-analysis. Asian J Urol 10(3):317\u0026ndash;328\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang J et al (2023) Robot-assisted versus open radical prostatectomy: a systematic review and meta-analysis of prospective studies. J Robot Surg 17(6):2617\u0026ndash;2631\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKulthe Ramesh SB et al (2026) Current Surgical Treatment of Prostate Cancer. Urologic Clin 53(1):135\u0026ndash;152\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAli SN et al (2024) Feasibility and Outcomes of Same-Day Discharge after Multiport Robot-Assisted Radical Prostatectomy. J Endourol 38(12):1346\u0026ndash;1352\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFranco A et al (2025) Single port robot-assisted radical and simple prostatectomy: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 28(1):117\u0026ndash;128\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheccucci E et al (2020) Single-port robot-assisted radical prostatectomy: a systematic review and pooled analysis of the preliminary experiences. BJU Int 126(1):55\u0026ndash;64\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNguyen TT et al (2023) Single-port and multiport robot-assisted radical prostatectomy: A meta-analysis. Prostate Int 11(4):187\u0026ndash;194\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi K et al (2022) Perioperative and Oncologic Outcomes of Single-Port vs Multiport Robot-Assisted Radical Prostatectomy: A Meta-Analysis. J Endourol 36(1):83\u0026ndash;98\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChierigo F et al (2026) Outcomes of robot-assisted radical prostatectomy with novel robotic platforms vs da Vinci multiport systems: a systematic review and network meta-analysis. Prostate Cancer Prostatic Dis 29(1):57\u0026ndash;72\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXiao X et al (2025) Perioperative efficiency and clinical outcomes of single-port versus multi-port robot-assisted radical prostatectomy: an updated meta-analysis. J Robot Surg 19(1):492\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFernandez-Mateos J et al (2024) Tumor evolution metrics predict recurrence beyond 10 years in locally advanced prostate cancer. Nat Cancer 5(9):1334\u0026ndash;1351\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKlingenberg S et al (2021) (68)Ga-PSMA PET/CT for Primary Lymph Node and Distant Metastasis NM Staging of High-Risk Prostate Cancer. J Nucl Med 62(2):214\u0026ndash;220\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMałkiewicz B et al (2021) External Validation of the Briganti Nomogram to Predict Lymph Node Invasion in Prostate Cancer-Setting a New Threshold Value. Life (Basel), 11(6)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFahmy O et al (2021) Single-Port versus Multiple-Port Robot-Assisted Radical Prostatectomy: A Systematic Review and Meta-Analysis. J Clin Med, 10(24)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGreenberg SA, Nguyen HG, Carroll PR et al (2022) Management of Extracapsular Extension and Positive Surgical Margins Following Robot-Assisted, Laparoscopic Radical Prostatectomy, in Robotic Urologic Surgery, P. Wiklund, Editors. Springer International Publishing: Cham. pp. 373\u0026ndash;384\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-9613058/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9613058/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground and Objectives:\u003c/h2\u003e \u003cp\u003eRobot-assisted radical prostatectomy is widely used for the treatment of prostate cancer. Compared with conventional multiport robotic surgery, single-port robotic surgery may reduce surgical trauma and facilitate postoperative recovery. However, most comparative studies of single-port and multiport robot-assisted radical prostatectomy have included mixed-risk populations. Evidence in patients with high-risk prostate cancer remains limited. These patients often have a higher risk of local progression, lymph node involvement and postoperative recurrence. Therefore, short-term pathological and oncological safety should be carefully assessed. This study compared perioperative, pathological, and early PSA outcomes between EDGE SP1000 single-port robot-assisted radical prostatectomy (SP-RARP) and da Vinci Xi multiport robot-assisted radical prostatectomy (MP-RARP) in patients with high-risk prostate cancer.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eThis single-center cohort study included patients with high-risk prostate cancer who underwent robot-assisted radical prostatectomy at the First Affiliated Hospital of Anhui Medical University between March 2025 and April 2026. Patients were assigned to the SP-RARP or MP-RARP group according to the robotic platform used. The initial cohort included 45 patients in the SP-RARP group and 45 patients in the MP-RARP group. To reduce selection bias from baseline differences, 1:1 propensity score matching was performed. Matching variables included age, body mass index, log10 preoperative PSA, MRI-measured prostate volume, preoperative hemoglobin, biopsy Grade Group 5, and neoadjuvant therapy. After matching, 35 patients in each group were included. Perioperative outcomes, pathological outcomes and early PSA outcomes were compared. Continuous variables were reported as medians with interquartile ranges. Categorical variables were reported as numbers and percentages. Covariate balance after matching was assessed using standardized mean differences. Multivariable adjusted analyses were also performed.\u003c/p\u003e\u003ch2\u003eMain Findings:\u003c/h2\u003e \u003cp\u003eFor perioperative outcomes, operative time was 133.00 (120.00\u0026ndash;151.50) min in the SP-RARP group and 115.00 (101.50\u0026ndash;157.00) min in the MP-RARP group, with no significant difference (P\u0026thinsp;=\u0026thinsp;0.324). Hemoglobin decrease was 18.00 (14.00\u0026ndash;31.00) g/L and 20.50 (13.25\u0026ndash;24.00) g/L, respectively (P\u0026thinsp;=\u0026thinsp;0.331). The percentage decrease in hemoglobin was 13.64% (9.62%\u0026ndash;20.45%) and 14.70% (10.16%\u0026ndash;17.08%), respectively (P\u0026thinsp;=\u0026thinsp;0.380). The median postoperative hospital stay was 4.00 days in both groups: 4.00 (4.00\u0026ndash;4.00) days in the SP-RARP group and 4.00 (4.00\u0026ndash;5.00) days in the MP-RARP group (P\u0026thinsp;=\u0026thinsp;0.363). For pathological outcomes, there were no significant differences in positive surgical margin rate, pelvic lymph node dissection rate, or lymph node positivity rate. The positive surgical margin rates were 48.6% and 54.3%, respectively (P\u0026thinsp;=\u0026thinsp;0.811). For early PSA outcomes, early PSA levels were 0.013 (0.010\u0026ndash;0.040) ng/mL in the SP-RARP group and 0.016 (0.010\u0026ndash;0.054) ng/mL in the MP-RARP group (P\u0026thinsp;=\u0026thinsp;0.610). The rates of PSA\u0026thinsp;\u0026ge;\u0026thinsp;0.03 ng/mL were 29.4% and 31.2%, respectively (P\u0026thinsp;=\u0026thinsp;1.000). In multivariable adjusted analyses, SP-RARP was not significantly associated with operative time, hemoglobin decrease, percentage decrease in hemoglobin, postoperative hospital stay, positive surgical margin, or early PSA\u0026thinsp;\u0026ge;\u0026thinsp;0.03 ng/mL.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eIn this single-center propensity score-matched cohort, EDGE SP1000 SP-RARP achieved perioperative, pathological, and early PSA outcomes comparable to those of da Vinci Xi MP-RARP in patients with high-risk prostate cancer. SP-RARP was not associated with higher rates of positive surgical margins, lymph node positivity or detectable early PSA. These findings suggest that EDGE SP1000 SP-RARP is feasible and shows short-term oncological safety in high-risk prostate cancer patients.\u003c/p\u003e","manuscriptTitle":"Comparison of perioperative and short-term oncological outcomes between single-port and multiport robot-assisted radical prostatectomy for high-risk prostate cancer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-12 10:08:55","doi":"10.21203/rs.3.rs-9613058/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4ea55a4b-49bd-4efb-b61c-e8ca48cf79a4","owner":[],"postedDate":"May 12th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Rejected","date":"2026-05-12T13:15:09+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-05-12T13:14:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-05-12T08:59:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Robotic Surgery","date":"2026-05-05T02:32:13+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-12T13:59:21+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-12 10:08:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9613058","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9613058","identity":"rs-9613058","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}