Single-port versus multi-port robotic radical prostatectomy in elderly patients

Background/Objectives: Single-port radical prostatectomy (SP-RARP) has been demonstrated to be a feasible and safe procedure, even in older patients. This study aims to compare multi-port radical prostatectomy (MP-RARP) with SP-RARP, with a particular focus on elderly patients. Methods: Patients who underwent SP-RARP or MP-RARP between January 2018 and December 2023 were retrospectively analyzed. Patients undergoing concomitant surgical procedures or diagnosed with locally advanced prostate cancer were excluded from this study. Patients were then stratified into two groups: Group A (age < 65 years) and Group B (age ≥ 65 years). Results: A total of 338 patients (153 MP-RARP and 185 SP-RARP) were retrospectively collected. In Group B, the length of stay (in hours) was significantly shorter for SP procedures compared to MP (18 (20.8) vs. 35 (17); p = 0.002), with a higher rate of same-day discharge in favor of SP (45 (54.9%) vs. 9 (16.7%); p < 0.001). Additionally, MP patients in Group B had a higher incidence of postoperative complications at both 30 days (19(35.2%) vs. 13 days (15.9%); p = 0.009) and 90 days (21(38.9%) vs. 14 days (17.1%); p = 0.004) compared to those undergoing SP. Multivariable logistic regression analysis identified SP as a protective factor against postoperative complications at 30 days (Odds ratio: 0.41; 95% CI: 0.15, 0.97; p value = 0.027) and 90 days (Odds ratio: 0.38; 95% CI: 0.17,0.788; p = 0.024). Additionally, length of stay was associated with postoperative complications at 30 days (Odds ratio: 1.02; 95% CI: 1.01, 1.13; p value = 0.046). Conclusions: SP-RARP is a safe and feasible option for elderly patients, offering a lower incidence of short-term postoperative complications compared to MP-RARP. Furthermore, same-day discharge is feasible even in elderly patients undergoing SP-RARP.