Salvage robotic radical prostatectomy

Kaffenberger, Samuel D.; Smith, Joseph A.

doi:10.4103/0970-1591.142074

Cited by 17 publications

(4 citation statements)

References 23 publications

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“… 17 18 19 Moreover, several feasibility studies on salvage radical prostatectomy (SRP), a technically formidable operation in irradiated patients, also suggest that CRP may be done safely in a selective group of patients. 20 Hence, the aforementioned studies on high-risk PCa patients along with the current findings provide a strong theoretical framework for safely performing CRP.…”

Section: Discussionmentioning

confidence: 64%

Risk of complications and urinary incontinence following cytoreductive prostatectomy: a multi-institutional study

et al. 2018

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Emerging evidence has suggested that cytoreductive prostatectomy (CRP) allows superior oncologic control when compared to current standard of care androgen deprivation therapy alone. However, the safety and benefit of cytoreduction in metastatic prostate cancer (mPCa) has not been proven. Therefore, we evaluated the incidence of complications following CRP in men newly diagnosed with mPCa. A total of 68 patients who underwent CRP from 2006 to 2014 at four tertiary surgical centers were compared to 598 men who underwent radical prostatectomy for clinically localized prostate cancer (PCa). Urinary incontinence was defined as the use of any pad. CRP had longer operative times (200 min vs 140 min, P < 0.0001) and higher estimated blood loss (250 ml vs 125 ml, P < 0.0001) compared to the control group. However, both overall (8.82% vs 5.85%) and major complication rates (4.41% vs 2.17%) were comparable between the two groups. Importantly, urinary incontinence rate at 1-year after surgery was significantly higher in the CRP group (57.4% vs 90.8%, P < 0.0001). Univariate logistic analysis showed that the estimated blood loss was the only independent predictor of perioperative complications both in the unadjusted model (OR: 1.18; 95% CI: 1.02–1.37; P = 0.025) and surgery type-adjusted model (OR: 1.17; 95% CI: 1.01–1.36; P = 0.034). In conclusion, CRP is more challenging than radical prostatectomy and associated with a notably higher incidence of urinary incontinence. Nevertheless, CRP is a technically feasible and safe surgery for selecting PCa patients who present with node-positive or bony metastasis when performed by experienced surgeons. A prospective, multi-institutional clinical trial is currently underway to verify this concept.

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Section: Discussionmentioning

confidence: 64%

Risk of complications and urinary incontinence following cytoreductive prostatectomy: a multi-institutional study

et al. 2018

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“…Contrarily, Kaffenberger et al. 14 reported a lower risk of anastomotic stricture in robotic SRP, ranging from 0 to 17% versus 11% to 30% in the open approach group. In our series, we reported a stricture incidence of 8.7%; all of them occurred in patients who underwent the open approach (p-value = 0.07).…”

Section: Discussionmentioning

confidence: 98%

Comparing open and robotic salvage radical prostatectomy after radiotherapy: predictors and outcomes

Martínez

Romeo

Tobía

et al. 2021

Prostate International

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Introduction In the present study, we aim to provide more evidence about benefits of salvage radical prostatectomy (SRP). Our main objective is to assess prostatic-specific antigen control and postoperative urinary incontinence in open and robotic approaches as primary outcomes. Materials and methods After the Institutional Review Board approval (IRB00010193), we retrospectively analyzed 76 consecutive patients who underwent open or robot-assisted SRP for locally relapsed prostate cancer between 2004 and 2019 at the Urology Department of Hospital Italiano de Buenos Aires, Argentina. Data were collected from our electronic medical record and prospective database. Postoperative variables, such as urinary incontinence, erectile function preservation, and vesicourethral anastomosis stricture development, were analyzed. Results Before SRP, 59 patients (76.6%) were treated with 3D external beam radiotherapy, 11 (14.3%) with brachytherapy, and 6 (7.8%) with intensity-modulated radiotherapy. Fifty patients underwent open SRP, and 26, robot-assisted SRP. Comparing surgical approaches, the global incontinence rate was 34.2% versus 9.1% in open versus robot-assisted approach, respectively (p: 0.01). Vesicourethral anastomosis stricture occurred in six patients (8.7%), all in the open approach group (p: 0.07). Five patients of 69 (7.2%) preserved erectile function with/without use of phosphodiesterase 5 inhibitors. Two patients in the open approach group needed blood transfusion. Estimated 2-year biochemical recurrence–free survival rate in the open approach group and robot-assisted group was 67% (95% confidence interval: 53.7–80.3) and 60.9% (95% confidence interval: 40.5–81.3), respectively, with no statistical difference (log-rank test p: 0.873). Conclusions Robot-assisted SRP is a reliable procedure to treat local recurrences after external beam radiotherapy or brachytherapy, reducing the risk of anastomotic strictures and blood loss and improving continence outcomes.

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“…Indeed, of the 4 men with an anastomotic stricture in our series two ultimately required urinary diversion to manage this complication. Previous reports have noted that the risk of anastomotic stricture in significantly lower after robotic assisted than open radical prostatectomy in both the primary and salvage setting [ 14 ]. The two patients treated with robotic surgery in our series did not develop an anastomotic stricture.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of salvage radical prostatectomy following more than one failed local therapy

2018

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PurposeTo describe the salvage radical prostatectomy (sRP) experience in patients presenting with recurrent, clinically localized prostate cancer after multiple failed local treatments.Materials and MethodsAmong the 251 sRP performed during 2000–2016, 11 patients had failed multiple local therapies. We describe baseline clinical characteristics at primary cancer diagnosis and prior to sRP, surgical information, complications and oncological outcomes.ResultsThe mean±standard deviation age at sRP was 65±5 years and the median (interquartile range) serum prostate-specific antigen (PSA) level was 2 (1.3) ng/mL. The most common first and subsequent treatments were radiotherapy and cryotherapy, respectively, with median time of 24 months from the last local treatment. The median operative time was 180 minutes and median estimated blood loss was 750 mL. Five (45.5%) patients underwent additional procedures during sRP for pre-operative morbidity from prior treatments (rectourethral fistula, urethral stricture, incontinence). Post-operative complications requiring invasive intervention occurred in 7 (63.6%) patients. Over a median follow-up of 29 (12–96) months, 10 of the 11 men (90.9%) achieved an undetectable PSA in after sRP. Three of these men with an initially undetectable PSA level experienced biochemical recurrence; the remaining 7 are without evidence of disease. Overall, no local recurrence or systemic metastasis was identified at last follow-up.ConclusionssRP is technically feasible and offers durable cancer control in patients with recurrent prostate cancer despite having undergone multiple prior attempts at cure. These patients experience higher rates of post-operative complications and such patients must be appropriately counseled regarding the potential risks and benefits.

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Salvage robotic radical prostatectomy

Cited by 17 publications

References 23 publications

Risk of complications and urinary incontinence following cytoreductive prostatectomy: a multi-institutional study

Risk of complications and urinary incontinence following cytoreductive prostatectomy: a multi-institutional study

Comparing open and robotic salvage radical prostatectomy after radiotherapy: predictors and outcomes

Outcomes of salvage radical prostatectomy following more than one failed local therapy

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