Techniques and Outcomes of Salvage Robot-Assisted Radical Prostatectomy (sRARP).
Prostate cancer
outcomes
prostatectomy
robot-assisted surgery
salvage
techniques
Journal
European urology
ISSN: 1873-7560
Titre abrégé: Eur Urol
Pays: Switzerland
ID NLM: 7512719
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
received:
01
03
2020
accepted:
03
05
2020
pubmed:
29
5
2020
medline:
23
7
2021
entrez:
29
5
2020
Statut:
ppublish
Résumé
Salvage Robot-Assisted Radical Prostatectomy (sRARP) has been described as feasible treatment for the management of localised prostate cancer (PCa) recurrence after primary treatment. However, no large reports have published cancer and quality outcomes. To report perioperative, functional and oncologic outcomes of sRARP in patients with localised PCa recurrence. We retrospectively evaluated 106 patients with local recurrence eligible for sRARP. Surgery was performed using the DaVinci Si system similar to the standard approach but with adaptation to the primary treatment. Peri-operative outcomes included 90-day complication rate. Functional outcomes included rates of incontinence and erectile dysfunction. Oncological outcomes included tumour staging, margin rate and recurrence. Primary treatment was High Intensity Focused Ultrasound (HIFU) in 59 (56%) patients, 27 (25%) radiotherapy, 10 (9%) seed brachytherapy, 8 (8%) solitary androgen deprivation therapy (ADT), one (1%) cryotherapy and one (1%) electroporation / Nanoknife. Median follow-up was 2.1 years. 90-day complication rate was 8%. At two years or more, 50% were fully continent and 33% were socially continent. Continence rates tended to be better after focal compared to whole-gland treatments. Erectile dysfunction was present in 95%. Positive surgical margin rate was 39%. Biochemical recurrence occurred in 13% and local or metastatic recurrence in 11%. sRARP is technically more challenging but is a feasible option in high-volume centres for treatment of recurrent PCa. Patients should be counselled that functional outcomes are inferior to primary RARP. Adjustment of surgical technique according to the primary treatment is key for good surgical outcomes. We report our experience with sRARP for the management of localised PCa recurrence after primary treatment. This represents a feasible approach with acceptable peri-operative complications and cancer outcomes. Functional outcomes are inferior to RARP in the primary setting.
Sections du résumé
BACKGROUND
Salvage Robot-Assisted Radical Prostatectomy (sRARP) has been described as feasible treatment for the management of localised prostate cancer (PCa) recurrence after primary treatment. However, no large reports have published cancer and quality outcomes.
OBJECTIVE
To report perioperative, functional and oncologic outcomes of sRARP in patients with localised PCa recurrence.
DESIGN, SETTING, AND PARTICIPANTS
We retrospectively evaluated 106 patients with local recurrence eligible for sRARP.
SURGICAL PROCEDURE
Surgery was performed using the DaVinci Si system similar to the standard approach but with adaptation to the primary treatment.
MEASUREMENTS
Peri-operative outcomes included 90-day complication rate. Functional outcomes included rates of incontinence and erectile dysfunction. Oncological outcomes included tumour staging, margin rate and recurrence.
RESULTS AND LIMITATIONS
Primary treatment was High Intensity Focused Ultrasound (HIFU) in 59 (56%) patients, 27 (25%) radiotherapy, 10 (9%) seed brachytherapy, 8 (8%) solitary androgen deprivation therapy (ADT), one (1%) cryotherapy and one (1%) electroporation / Nanoknife. Median follow-up was 2.1 years. 90-day complication rate was 8%. At two years or more, 50% were fully continent and 33% were socially continent. Continence rates tended to be better after focal compared to whole-gland treatments. Erectile dysfunction was present in 95%. Positive surgical margin rate was 39%. Biochemical recurrence occurred in 13% and local or metastatic recurrence in 11%.
CONCLUSIONS
sRARP is technically more challenging but is a feasible option in high-volume centres for treatment of recurrent PCa. Patients should be counselled that functional outcomes are inferior to primary RARP. Adjustment of surgical technique according to the primary treatment is key for good surgical outcomes.
PATIENT SUMMARY
We report our experience with sRARP for the management of localised PCa recurrence after primary treatment. This represents a feasible approach with acceptable peri-operative complications and cancer outcomes. Functional outcomes are inferior to RARP in the primary setting.
Identifiants
pubmed: 32461073
pii: S0302-2838(20)30343-2
doi: 10.1016/j.eururo.2020.05.003
pii:
doi:
Types de publication
Journal Article
Video-Audio Media
Langues
eng
Sous-ensembles de citation
IM
Pagination
885-892Informations de copyright
Copyright © 2020. Published by Elsevier B.V.