Salvage radical prostatectomy for recurrent prostate cancer: morbidity and functional outcomes from a large multicenter series of open versus robotic approaches.

Salvage radical prostatectomy (sRP) historically yields poor functional outcomes and high complication rates. However, recent reports on robotic sRP have demonstrated improved results. In this study, we assessed sRP functional outcomes and complications, comparing robotic and open approaches.

We retrospectively collected data of sRP for recurrent prostate cancer (PCa) after local non-surgical treatment at 18 tertiary referral centers, from 2000 to 2016. The Clavien-Dindo classification was employed to classify complications. Complications and functional outcomes were evaluated in a uni- and multivariable analysis.

We included 395 sRP (n=186 open; n=209 robotic). The robotic-sRP yielded lower BL (p<0.0001) and shorter HS (p<0.0001). No significant differences emerged in major (10.1%, p=0.16) and overall complications (34.9%, p=0.67), including an overall low risk of rectal injuries and fistulas (1.58% and 2.02% respectively); however, anastomotic stricture was more frequent for open-sRP (16.57% vs 7.66%; p<0.01). Overall 24.6% had severe (≥3pads/day) incontinence (12 or 6mo). On multivariable analysis robotic-sRP was an independent predictor for continence preservation (OR 0.411, 95% CI 0.232-0.727, p=0.022). Limitations include the retrospective nature and absence of standardized surgical technique.

In a contemporary series, sRP showed a low risk of major complications and better functional outcomes than previously reported. Robotic-sRP may reduce anastomotic strictures, blood loss, and hospital stay, and improve continence outcomes.

The Journal of urology. 2019 May 10 [Epub ahead of print]

Paolo Gontero, Giancarlo Marra, Paolo Alessio, Claudia Filippini, Marco Oderda, Fernando Munoz, Estefania Linares, Rafael Sanchez-Salas, Ben Challacombe, Prokar Dasgupta, Sanchia Goonewardene, Rick Popert, Declan Cahill, David Gillatt, Raj Persad, Juan Palou, Steven Joniau, Thierry Piechaud, Alessandro Morlacco, Sharma Vidit, Morgan Roupret, Alexandre De La Taille, Simone Albisinni, Giorgio Gandaglia, Alexander Mottrie, Shreyas Joshi, Gabriel Fiscus, Andre Berger, Monish Aron, Henk Van Der Poel, Derya Tilki, Nathan Lawrentschuk, Declan G Murphy, Gordon Leung, John Davis, Robert Jeffrey Karnes

Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin , Turin , Italy., Department of Statistics, University of Turin , Turin , Italy., Department of Radiotherapy, Parini Hospital , Aosta , Italy., Department of Urology, Institut Mutualiste Montsouris , Paris , France., Department of Urology, Urology Centre, Guy's Hospital , London , UK., Department of Urology, Royal Marsden Hospital , London , UK., Department of Urology, Bristol NHS Foundation Trust , Bristol , UK., Department of Urology, Fundaciò Puigvert , Barcelona , Spain., Department of Urology, Leuven University Hospitals , Leuven , Belgium., Department of Urology, Clinique Saint Augustin , Bordeaux , France., Department of Urology, Mayo Clinic , Rochester , MN , USA., Department of Urology, Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, F-75013 Paris , France., Department of Urology, CHU Mondor , Créteil , France., Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles , Bruxelles , Belgium., Department of Urology, OLV Hospital , Aalst , Belgium., Department of Urology, Vanderbilt University, Medical Center North , Nashville , TN , USA., Department of Urology, USC Norris Comprehensive Cancer Center and Hospital, University of Southern California , CA , USA., Department of Urology, Netherlands Cancer Institute , Amsterdam , Netherlands., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf , Hamburg , Germany., Division of Cancer Surgery, Peter MacCallum Cancer Centre , Melbourne , Victoria , Australia., Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center , Houston , TX , USA.