OBJECTIVE: To determine the perioperative outcomes of men undergoing robotic salvage prostatectomy (RSP).
To examine the complications, functional consequences, and need for additional treatments after RSP.
MATERIALS AND METHODS: 51 consecutive patients underwent RSP after previous failed local therapy. Biochemical recurrence was defined as two postoperative PSAs ≥ 0.2 ng/mL. Complications at any time postoperatively were recorded prospectively by a modified Clavien system. The Kaplan-Meier method was used for survival estimation and regression models were used to identify predictors of biochemical recurrence or progression free survival and complications.
RESULTS: Median age at RSP was 68 years with a median of 68 months elapsed from time of primary treatment, median follow-up was 36 months. Median operative time was 179 minutes with estimated blood loss of 175 ml 50% of patients were pathologic stage 3 and positive surgical margins were seen in 31%. Estimated 3-year biochemical recurrence or progression free survival was 57%. Overall complication rate was 47% with 35% major complication (Grade III-V) rate. Potency was maintained in 23% of preoperatively potent men and 45% of all patients regained urinary control. No clinical variables were predictive of major complications, however all patients with postoperative bladder neck contracture were incontinent. Higher PSA and extracapsular extension were significantly associated with biochemical recurrence or progression (p< .01).
CONCLUSION: Robotic salvage prostatectomy provides oncologic control with potential avoidance of systemic non-curative therapy. Complication, incontinence, and erectile dysfunction rates are significant but frequently correctable. This reinforces the need for proper patient counseling and selection.
Written by:
Yuh B, Ruel N, Muldrew S, Mejia R, Novara G, Kawachi M, Wilson T. Are you the author?
City of Hope National Cancer Center, Urology, Duarte, CA.
Reference: BJU Int. 2013 Dec 6. doi: 10.1111/bju.12595.
doi: 10.1111/bju.12595
PubMed Abstract
PMID: 24314031
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