79 Salvage Robotic-Assisted Radical Prostatectomy (sRALP) for treatment of radio-recurrent prostate cancer: Description of technique and multi-institutional outcomes

Coelho, Rafael F.; Patel, Manoj; Chauhan, Sanket; Orvieto, M.A.; Ardila, B.; Liss, Michael A.; Ahlering, Thomas E.; Ferrigni, Robert G.; Castle, EP; Joseph, Jean; Sivaraman, Ananthakrishnan; Rocco, B.; Palmer, K.; Patel, V.

doi:10.1016/s1569-9056(10)61170-0

Cited by 3 publications

(2 citation statements)

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“…Salvage radical prostatectomy (sRP) is a challenging procedure that is rarely performed, although it represents a guidelines-validated option for BCR after primary nonsurgical treatment. The historical series of sRP with frequent major complications, such as rectal injury and poor functional outcomes [5], have played a major role in the low use of this option in a salvage situation. However, minimally invasive approaches may provide significant improvements, which could lead to improved functional outcomes and reduced complications [6,7].…”

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confidence: 99%

Salvage Radical Prostatectomy for Recurrent Prostate Cancer: A Systematic Review (French ccAFU)

Saouli,

Ruffion,

Dariane

et al. 2023

Cancers

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The aim of this study was to systematically review the current evidence regarding the oncological and functional outcomes of salvage radical prostatectomy (sRP) for recurrent prostate cancer. A systematic review was conducted throughout September 2022 using the PubMed, Science Direct, Scopus, and Embase databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. A total of 55 studies (3836 patients) met our eligibility criteria. The vast majority of men included had radiation therapy (including brachytherapy) as their first-line treatment (n = 3240, 84%). Other first-line treatments included HIFU (n = 338, 9%), electroporation (n = 59, 2%), proton beam therapy (n = 54, 1.5%), cryotherapy (n = 34, 1%), focal vascular targeted photodynamic therapy (n = 22, 0.6%), and transurethral ultrasound ablation (n = 19, 0.5%). Median preoperative PSA, at the time of recurrence, ranged from 1.5 to 14.4 ng/mL. The surgical approach was open in 2300 (60%) cases, robotic in 1465 (38%) cases, and laparoscopic in 71 (2%) cases. Since 2019, there has been a clear increase in robotic versus conventional surgery (1245 versus 525 cases, respectively). The median operative time and blood loss ranged from 80 to 297 min and 75 to 914 mL, respectively. Concomitant lymph node dissection was performed in 2587 cases (79%). The overall complication rate was 34%, with a majority of Clavien grade I or II complications. Clavien ≥ 3 complications ranged from 0 to 64%. Positive surgical margins were noted in 792 cases (32%). The median follow-up ranged from 4.6 to 94 months. Biochemical recurrence after sRP ranged from 8% to 51.5% at 12 months, from 0% to 66% at 22 months, and from 48% to 59% at 60 months. The specific and overall survival rates ranged from 13.4 to 98% and 62 to 100% at 5 years, respectively. Urinary continence was maintained in 52.1% of cases. sRP demonstrated acceptable oncological outcomes. These results, after sRP, are influenced by several factors, and above all by pre-treatment assessment, including imaging, with the development of mpMRI and metabolic imaging. Our results demonstrated that SRP can be considered a suitable treatment option for selected patients, but the level of evidence remains low.

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Section: Introductionmentioning

confidence: 99%

Salvage Radical Prostatectomy for Recurrent Prostate Cancer: A Systematic Review (French ccAFU)

Saouli,

Ruffion,

Dariane

et al. 2023

Cancers

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“…Historically, sRP has shown inferior oncological and functional outcomes to primary radical prostatectomy with higher postoperative complication rates. The poor outcomes associated with sRP may be due to the technical hazards of surgery such as adhesions, fibrosis, poor tissue quality, and distortion of surgical planes that result from the primary treatment modality [3].…”

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confidence: 99%

283 Salvage Versus Primary Robot-Assisted Radical Prostatectomy: A Propensity-Matched Comparative Effectiveness Study from A High-Volume Tertiary Centre

Nathan

Fricker

Groote

et al. 2021

British Journal of Surgery

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Aim Salvage Robot-Assisted Radical Prostatectomy (sRARP) is a potential treatment option for locally recurrent Prostate Cancer after non-surgical primary treatment. There are minimal data comparing outcomes between propensity-matched salvage and primary Robot-Assisted Radical Prostatectomy (RARP). We compare perioperative, oncological, and functional outcomes of sRARP with primary RARP and between sRARP post-whole and focal gland therapy. Method 1:1 propensity-matched comparison of 146 sRARP with primary RARP from a cohort of 3,852 consecutive patients from a high-volume tertiary centre. Results There were no significant differences in patient characteristics between the salvage and primary RARP groups. Grade III-V Clavien-Dindo complication rates were 1.3% and 0% in the salvage and primary groups, respectively (p = 0.310). Median (IQR) follow-up was 16 (10,30) and 21 (13,33) months in the salvage and primary groups, respectively. BCR rates were 30.8% and 13.7% in the salvage and primary groups, respectively (p < 0.001). Pad-free continence rates were 79.1% and 85.4% at two years in the salvage and primary groups, respectively (p = 0.160). ED rates were 95.2% and 77.4% in the salvage and primary groups, respectively (p < 0.001). Comparing the whole gland and focal gland groups, BCR rates were 33.3% and 29.1%, respectively (p = 0.687), pad-free continence rates were 66% and 89.3%, respectively (p = 0.001), and ED rates were 98.3% and 93%, respectively (p = 0.145). Conclusions SRARP has similar perioperative but inferior oncological outcomes to primary RARP. Continence rates are similar to primary RARP, but potency is worse. Perioperative and oncological outcomes of sRARP after focal gland therapy are similar but continence outcomes are superior compared to sRARP after whole gland therapy.

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L’essentiel du congrès de l’ERUS 2010

Descazeaud

2011

Progrès en Urologie

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79 Salvage Robotic-Assisted Radical Prostatectomy (sRALP) for treatment of radio-recurrent prostate cancer: Description of technique and multi-institutional outcomes

Cited by 3 publications

References 0 publications

Salvage Radical Prostatectomy for Recurrent Prostate Cancer: A Systematic Review (French ccAFU)

Salvage Radical Prostatectomy for Recurrent Prostate Cancer: A Systematic Review (French ccAFU)

283 Salvage Versus Primary Robot-Assisted Radical Prostatectomy: A Propensity-Matched Comparative Effectiveness Study from A High-Volume Tertiary Centre

L’essentiel du congrès de l’ERUS 2010

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