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Salvage robotic-assisted radical prostatectomy: oncologic and functional outcomes from two high-volume institutions

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Abstract

Introduction

While no consensus on the optimal salvage treatment exists, only 3% of these patients will get salvage radical prostatectomies due to the assumed technical challenges of this procedure.

Objectives

Our goal is to analyze the perioperative, oncologic and functional outcomes of patients undergoing salvage robotic-assisted radical prostatectomy (sRARP) after primary treatment failure.

Materials and methods

Data were prospectively collected and retrospectively reviewed from a combined database of more than 14,800 patients who had undergone RARP. We identified 96 patients who underwent sRARP after RT or ablative techniques. Primary cancer characteristics, surgical data, pathology results, perioperative complications, oncologic and functional outcomes were analyzed.

Results

Sixty-eight patients (70.8%) received some source of RT as a primary treatment. The remaining 28 patients: 18 (18.75%) received cryotherapy, seven (7.92%) HIFU, one electroporation, one microwave and one Tookad. complication was seen in 25 (26%) patients (21 minor and 4 major complications). Anastomotic leak was the most common complication, found in 14 (14.6%) of the cases. No rectal injuries occurred. Fourteen (15%) patients had a biochemical failure after a median follow-up of 14 (IQR 5–24) months. Fifty-five (57.3%) of them self-reported to be pad-free at 12 months. Seventeen (55%) of 31 pre-operative potent patients (SHIM score > 21), were potent with or without the use of PDE5i at 12 months.

Conclusions

sRARP is a feasible alternative for PCa recurrence. Technically the procedure is challenging and should be performed by experienced PCa surgeons. Major complications are uncommon. Continence and potency recovery is possible, but at lower rates than for non-salvage patients.

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References

  1. Siegel RL, Miller KD, Jemal A (2015) Cancer statistics, 2015. CA Cancer J Clin 65:5–29

    Article  Google Scholar 

  2. Agarwal PK, Sadetsky N, Konety BR et al (2008) Treatment failure after primary and salvage therapy for prostate cancer: likelihood, patterns of care, and outcomes. Cancer 112:307–314

    Article  Google Scholar 

  3. Gelet A, Chapelon JY, Poissonnier L et al (2004) Local recurrence of prostate cancer after external beam radiotherapy: early experience of salvage therapy using high-intensity focused ultrasonography. Urology 63:625–629

    Article  Google Scholar 

  4. Bianco FJ Jr, Scardino PT, Stephenson AJ et al (2005) Long-term oncologic results of salvage radical prostatectomy for locally recurrent prostate cancer after radiotherapy. Int J Radiat Oncol 62:448–453

    Article  Google Scholar 

  5. Henríquez I, Sancho G, Hervás A et al (2014) Salvage brachytherapy in prostate local recurrence after radiation therapy: predicting factors for control and toxicity. Radiat Oncol 9:102

    Article  Google Scholar 

  6. Linares Espinós E, Sánchez-Salas R, Sivaraman A et al (2016) Minimally invasive salvage prostatectomy after primary radiation or ablation treatment. Urology 94:111–116

    Article  Google Scholar 

  7. Yuh B, Ruel N, Muldrew S et al (2014) Complications and outcomes of salvage robot-assisted radical prostatectomy: a single-institution experience. BJU Int 113:769–776

    Article  Google Scholar 

  8. Kaffenberger SD, Keegan KA, Bansal NK et al (2013) Salvage robotic assisted laparoscopic radical prostatectomy: a single institution, 5-year experience. J Urol 189:507–513

    Article  Google Scholar 

  9. Eandi JA, Link BA, Nelson RA et al (2010) Robotic assisted laparoscopic salvage prostatectomy for radiation resistant prostate cancer. J Urol 183:133–137

    Article  Google Scholar 

  10. Zugor V, Labanaris AP, Porres D et al (2014) Robot-assisted radical prostatectomy for the treatment of radiation-resistant prostate cancer: surgical, oncological and short-term functional outcomes. Urol Int 92(1):20–26

    Article  Google Scholar 

  11. Kenney PA, Nawaf C, Mustafa M et al (2016) Robotic-assisted laparoscopic versus open salvage radical prostatectomy following radiotherapy. Can J Urol 23(3):8265–8271

    Google Scholar 

  12. Patel VR, Schatloff O, Chauhan S et al (2012) The role of the prostatic vasculature as a landmark for nerve sparing during robot-assisted radical prostatectomy. Eur Urol 61(3):571–576

    Article  Google Scholar 

  13. Ko YH, Coelho RF, Sivaraman A et al (2013) Retrograde versus antegrade nerve sparing during robot-assisted radical prostatectomy: which is better for achieving early functional recovery? Eur Urol 63(1):169–177

    Article  Google Scholar 

  14. Patel VR, Coelho RF, Palmer KJ et al (2009) Periurethral suspension stitch during robot-assisted laparoscopic radical prostatectomy: description of the technique and continence outcomes. Eur Urol 56(3):472–478

    Article  Google Scholar 

  15. Gautam G, Rocco B, Patel VR, Zorn KC (2010) Posterior rhabdosphincter reconstruction during robot-assisted radical prostatectomy: critical analysis of techniques and outcomes. Urology 76(3):734–741

    Article  Google Scholar 

  16. Ogaya-Pinies G, Kadakia Y, Palaypalayam-Ganapathi H et al (2016) Use of scaffolding tissue biografts to bolster vesicourethral anastomosis during salvage robot-assisted prostatectomy reduces leak rates and catheter times. Eur Urol 74(1):92–98

    Article  Google Scholar 

  17. Vallancien G, Gupta R, Cathelineau X et al (2003) Initial results of salvage laparoscopic radical prostatectomy after radiation failure. J Urol 170:1838–1840

    Article  Google Scholar 

  18. Thompson I, Thrasher JB, Aus G, Burnett AL, Canby-Hagino ED, Cookson MS et al (2007) Guideline for the management of clinically localized prostate cancer: 2007 update. J Urol 177(6):2106–2131

    Article  Google Scholar 

  19. Ou YC, Yang CK, Wang J et al (2013) The trifecta outcome in 300 consecutive cases of robotic-assisted laparoscopic radical prostatectomy according to D’Amico risk criteria. Eur J Surg Oncol 39(1):107–113

    Article  CAS  Google Scholar 

  20. True LD (1994) Surgical pathology examination of the prostate gland: practice survey by the America Society of Clinical Pathologist. Am J Clin Pathol 102:572–579

    Article  CAS  Google Scholar 

  21. Green FL, Dl Page, Fleming ID et al (2002) American joint committee on cancer staging manual, vol 6. Springer, New York

    Book  Google Scholar 

  22. Schatloff O, Chauhan S, Sivaraman A et al (2012) Anatomic grading of nerve sparing during robot-assisted radical prostatectomy. Eur Urol 61:786–802

    Article  Google Scholar 

  23. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and result of a survey. Ann Surg 240:205–213

    Article  Google Scholar 

  24. Pound CR, Partin AW, Eisenberger MA et al (1999) Natural history of progression after PSA elevation following radical prostatectomy. JAMA 281:1591–1597

    Article  CAS  Google Scholar 

  25. Heidenreich A, Bastian PJ, Bellmunt J et al (2013) EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent-update. Eur Urol 2014(65):124–137

    Google Scholar 

  26. Kolodziej M (2014) Management of biochemically recurrent prostate cancer following local therapy. Am J Manag Care 20:S273–S281

    PubMed  Google Scholar 

  27. Ficarra V, Novara G, Rosen RC et al (2012) Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol 62(3):405–417

    Article  Google Scholar 

  28. Patel VR, Sivaraman A, Coelho RF et al (2011) Pentafecta: a new concept for reporting outcomes of robot-assisted laparoscopic radical prostatectomy. Eur Urol 59(5):702–707

    Article  Google Scholar 

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Authors and Affiliations

  1. Hospital Universitario Rey Juan Carlos, C/Gladiolo s/n, 28933, Mostoles, Madrid, Spain

    Gabriel Ogaya-Pinies

  2. Hospital Universitario La Paz, Madrid, Spain

    Estefania Linares-Espinos

  3. University of Central, Florida School of Medicine and Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA

    Eduardo Hernandez-Cardona, Cathy Jenson & Vipul Patel

  4. Institut Mutualiste Montsouris, Paris, France

    Xavier Cathelineau & Rafael Sanchez-Salas

Authors
  1. Gabriel Ogaya-Pinies
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  2. Estefania Linares-Espinos
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  3. Eduardo Hernandez-Cardona
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  4. Cathy Jenson
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  5. Xavier Cathelineau
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  6. Rafael Sanchez-Salas
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  7. Vipul Patel
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Contributions

GOP project development, data analysis, manuscript writing. ELE data collection, data analysis, manuscript editing. EC data collection, manuscript writing. CJ manuscript writing and editing. XC project development, manuscript editing. RSS project development, data analysis, manuscript editing. VP project development, data analysis, manuscript editing.

Corresponding author

Correspondence to Gabriel Ogaya-Pinies.

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Conflict of interest

All authors have no conflict of interest to declare. This project includes human participants, but all procedures performed are within the regular clinical practice, no experimental procedures were performed and all the patients signed an informed consent before the treatment.

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Ogaya-Pinies, G., Linares-Espinos, E., Hernandez-Cardona, E. et al. Salvage robotic-assisted radical prostatectomy: oncologic and functional outcomes from two high-volume institutions. World J Urol 37, 1499–1505 (2019). https://doi.org/10.1007/s00345-018-2406-4

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  • DOI: https://doi.org/10.1007/s00345-018-2406-4

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