Paolo Gontero1, Giancarlo Marra1, Paolo Alessio1, Claudia Filippini2, Marco Oderda1, Fernando Munoz3, Estefania Linares4, Rafael Sanchez-Salas4, Ben Challacombe5, Prokar Dasgupta5,6, Sanchia Goonewardene5, Rick Popert5, Declan Cahill7, David Gillatt8, Raj Persad8, Juan Palou9, Steven Joniau10, Thierry Piechaud11, Alessandro Morlacco12, Sharma Vidit12, Morgan Rouprêt13, Alexandre De La Taille14, Simone Albisinni15, Giorgio Gandaglia16, Alexander Mottrie16, Shreyas Joshi17, Gabriel Fiscus17, Andre Berger18, Monish Aron18, Henk Van Der Poel19, Derya Tilki20, Nathan Lawrentschuk21, Declan G Murphy21, Gordon Leung22, John Davis22, Robert Jeffrey Karnes23. 1. Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy. 2. Department of Statistics, University of Turin, Turin, Italy. 3. Department of Radiotherapy, Parini Hospital, Aosta, Italy. 4. Department of Urology, Institut Mutualiste Montsouris, F-75013 Paris, France. 5. Urology 47 Centre, Guy's Hospital, London, United Kingdom. 6. King's College London, London, United Kingdom. 7. Royal Marsden Hospital, London, United Kingdom. 8. Bristol NHS Foundation Trust, Bristol, United Kingdom. 9. Fundaciò Puigvert, Barcelona, Spain. 10. Leuven University Hospitals, Leuven, Belgium. 11. Clinique Saint Augustin, Bordeaux, France. 12. Mayo Clinic, Rochester, Minnesota. 13. Sorbonne Université, GRC No. 5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, F-75013 Paris, France. 14. CHU Mondor, Créteil, France. 15. Institut Jules Bordet, Université Libre de Bruxelles, Bruxelles, Belgium. 16. OLV Hospital, Aalst, Belgium. 17. Vanderbilt University, Medical Center North, Nashville, Tennessee. 18. USC Norris Comprehensive Cancer Center and Hospital, University of Southern California, California. 19. Netherlands Cancer Institute, Amsterdam, Netherlands. 20. Martini-Klinik Prostate Cancer Center and Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 21. Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne and Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia. 22. Division of Surgery, Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas. 23. Department of Oncology, University of Turin, Turin, Italy.
Abstract
PURPOSE: Salvage radical prostatectomy has historically yielded a poor functional outcome and a high complication rate. However, recent reports of robotic salvage radical prostatectomy have demonstrated improved results. In this study we assessed salvage radical prostatectomy functional outcomes and complications when comparing robotic and open approaches. MATERIALS AND METHODS: We retrospectively collected data on salvage radical prostatectomy for recurrent prostate cancer after local nonsurgical treatment at 18 tertiary referral centers from 2000 to 2016. The Clavien-Dindo classification was applied to classify complications. Complications and functional outcomes were evaluated by univariable and multivariable analysis. RESULTS: We included 395 salvage radical prostatectomies, of which 186 were open and 209 were robotic. Robotic salvage radical prostatectomy yielded lower blood loss and a shorter hospital stay (each p <0.0001). No significant difference emerged in the incidence of major and overall complications (10.1%, p=0.16, and 34.9%, p=0.67), including an overall low risk of rectal injury and fistula (1.58% and 2.02%, respectively). However, anastomotic stricture was more frequent for open salvage radical prostatectomy (16.57% vs 7.66%, p <0.01). Overall 24.6% of patients had had severe incontinence, defined as 3 or more pads per day, for 12 or 6 months. On multivariable analysis robotic salvage radical prostatectomy was an independent predictor of continence preservation (OR 0.411, 95% CI 0.232-0.727, p=0.022). Limitations include the retrospective nature of the study and the absence of a standardized surgical technique. CONCLUSIONS: In this contemporary series to our knowledge salvage radical prostatectomy showed a low risk of major complications and better functional outcomes than previously reported. Robotic salvage radical prostatectomy may reduce anastomotic stricture, blood loss and hospital stay, and improve continence outcomes.
PURPOSE: Salvage radical prostatectomy has historically yielded a poor functional outcome and a high complication rate. However, recent reports of robotic salvage radical prostatectomy have demonstrated improved results. In this study we assessed salvage radical prostatectomy functional outcomes and complications when comparing robotic and open approaches. MATERIALS AND METHODS: We retrospectively collected data on salvage radical prostatectomy for recurrent prostate cancer after local nonsurgical treatment at 18 tertiary referral centers from 2000 to 2016. The Clavien-Dindo classification was applied to classify complications. Complications and functional outcomes were evaluated by univariable and multivariable analysis. RESULTS: We included 395 salvage radical prostatectomies, of which 186 were open and 209 were robotic. Robotic salvage radical prostatectomy yielded lower blood loss and a shorter hospital stay (each p <0.0001). No significant difference emerged in the incidence of major and overall complications (10.1%, p=0.16, and 34.9%, p=0.67), including an overall low risk of rectal injury and fistula (1.58% and 2.02%, respectively). However, anastomotic stricture was more frequent for open salvage radical prostatectomy (16.57% vs 7.66%, p <0.01). Overall 24.6% of patients had had severe incontinence, defined as 3 or more pads per day, for 12 or 6 months. On multivariable analysis robotic salvage radical prostatectomy was an independent predictor of continence preservation (OR 0.411, 95% CI 0.232-0.727, p=0.022). Limitations include the retrospective nature of the study and the absence of a standardized surgical technique. CONCLUSIONS: In this contemporary series to our knowledge salvage radical prostatectomy showed a low risk of major complications and better functional outcomes than previously reported. Robotic salvage radical prostatectomy may reduce anastomotic stricture, blood loss and hospital stay, and improve continence outcomes.
Authors: Giancarlo Marra; Taimur T Shah; Daniele D'Agate; Alessandro Marquis; Giorgio Calleris; Luca Lunelli; Claudia Filippini; Marco Oderda; Marco Gatti; Massimo Valerio; Rafael Sanchez-Salas; Alberto Bossi; Juan Gomez-Rivas; Francesca Conte; Desiree Deandreis; Olivier Cussenot; Umberto Ricardi; Paolo Gontero Journal: Front Surg Date: 2022-06-07
Authors: Arnas Rakauskas; Taimur T Shah; Max Peters; Jagpal S Randeva; Feargus Hosking-Jervis; Michael J Schmainda; Clement Orczyck; Mark Emberton; Manit Arya; Caroline Moore; Hashim U Ahmed Journal: Urol Oncol Date: 2021-05-26 Impact factor: 3.498