Presentation Authors: Paolo Gontero, Giancarlo Marra, Paolo Alessio, Giorgio Calleris, Antonino Battaglia, Claudia Filippini, Stefania Munegato, Torino, Italy, Fernando Munoz, Aosta, Italy, Marco Oderda, Anna Palazzetti, Francesca Pisano, Umberto Ricardi, Torino, Italy, Estefania Linares, Rafael Sanchez-Salas, Paris, France, Ben Challacombe, Paul Cathcart, Prokar Dasgupta, Sanchia Goonewardene*, Rick Popert, Declan Cahill, London, United Kingdom, David Gillatt, Raj Persad, Bristol, United Kingdom, Juan Palou, Barcelona, Spain, Steven Joniau, Leuven, Belgium, Thierry Piechaud, Salvatore Smelzo, Bordeaux, France, Alexandre De La Taille, Créteil, France, Morgan Roupret, Paris, France, Simone Albisinni, Roland Van Velthoven, Bruxelles, Belgium, Alessandro Morlacco, Sharma Vidit, Rochester, MN, Giorgio Gandaglia, Alexander Mottrie, Aalst, Belgium, Joseph Smith, Shreyas Joshi, Gabriel Fiscus, Nashville, TN, Andre Berger, Monish Aron, Andre Abreu, Inderbir S. Gill, Los Angeles, CA, Henk Van Der Poel, Amsterdam, Netherlands, Derya Tilki, Hamburg, Germany, Nathan Lawrentschuk, Declan G. Murphy, Melbourne, Victoria, Australia, Gordon Leung, John Davis, Houston, TX, Robert J. Karnes, Rochester, MN
Introduction: Salvage radical prostatectomy (sRP) has been associated with high complication rates and poor functional outcomes in the past, while latest sRP series have shown a substantial improvement. In this study, we assessed sRP functional outcomes and complications, comparing robotic and open approaches.
Methods: 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. Patient with insufficient follow-up ( < 6 mo) and/or lacking data on functional outcomes or complications were excluded. The Clavien-Dindo classification was employed to classify complications. Functional outcomes were assessed at baseline (before sRP) and at 6 and/or 12 months follow up.
Results: In total, 395 sRP (n=186 open; n=209 robotic) were included. At baseline, no differences were present apart from follow-up duration (p < 0.001), pre-sRP castration resistant PCa proportion (p=0.0055) (higher for open RP) and sRP Gleason (p=0.0159) (higher for robotic sRP). All patients were free from radiological evidence of extranodal metastases. Lower blood loss (p < 0.0001) and shorter hospital stay (p < 0.0001) were observed for robotic sRP, while no significant differences emerged in major (10.1%,p=0.16) and overall complications (34.9%,p=0.67). Risk of rectal injuries and fistulas was limited (respectively, 1.58% and 2.02%); anastomotic stricture was more common in open-sRP (16.6% vs 7.7%; p < 0.01). Overall, 57,5% of patients had improved/unchanged continence, whereas 24.6% experienced severe (â‰¥3pads/day) incontinence; spontaneous or PDE-5 assisted erections occurred in 8.1% of the cases (15.6% potent before sRP had preserved erectile function compared to pre-sRP). Considering nerve sparing procedures, 3 (11.5%) in 26 men with available results maintained spontaneous or PDE-5 assisted erections. Robotic approach was an independent predictor for continence preservation (OR 0.411, 95% CI 0.232-0.727, p=0.022) in multivariable analysis; previous hormonal treatment (OR 1.689, 95% CI 1.004-2.843, p=0.0484) and ASA score (OR 1.430, 95% CI 1.026-1.995, p=0.0349) were both significantly associated with the occurrence of one or more complications.
Conclusions: Our recent data on sRP performed in tertiary referral centers suggest a lower risk of major complications and better functional outcomes than previously reported. A reduction of blood loss, hospital stay, anastomotic strictures and improved continence were observed with the robotic technique.