Presentation Authors: Friederike Haidl*, David Pfister, Daniel Porres, Leonidas Karapanos, Johannes Salem, Axel Heidenreich, Cologne, Germany
Introduction: Local complications such as gross hematuria and clotting, repetitive blood transfusions, upper and lower urinary tract obstruction, intestinal obstruction, and treatment-refractory pelvic pain represent significant complications of locally advanced CRPC despite the use of life prolonging agents. It is the purpose of our study to retrospectively review the surgical, symptomatic and oncological outcome following palliative, extensive pelvic surgery.
Methods: 103 patients with locally advanced CRPC underwent palliative pelvic surgery: radical cystoprostatectomy in n=80 (61.5%), radical prostatectomy with continent vesicostomy in n=9 (8.7%) and anterior plus posterior exenteration in n=17 (16.5%). All patients underwent local staging via MRI of the small pelvis, cystoscopy and rectoscopy. Systemic staging was done with CT scans of the chest, abdomen, pelvis and bone scans. Perioperative complications were assessed according to Clavien-Dindo classification and symptom-free (SFS), cancer specific survival (CSS) were evaluated.
Results: Indications for surgery were lower or upper urinary tract obstruction in 56 (54.3%) and 41 (39.8%), resp., hematuria and blood transfusions in 23 (22.3%), rectal infiltration with/without obstructive ileus in 17 (16.5%), refractory pelvic pain in 13 (12.6%). 67 (65.1%) pts had a combination of various symptoms. Clavien-Dindo grade 2, 3 and 4 complications developed in 27 (26.2%), 9 (8.7%) and 6 (5.8%), resp. After a median follow-up of 36.5 (3 â€“ 123) months, the SFS at 1 and 3 years was 90.3% (n=90) and 66.9% (n=69). The median SFS was 27.9 months. CSS at 1 and 3 years was 92.2% and 43.7%, respectively. 78.6% of the patients were symptom-free during their remaining lifetime.
Conclusions: Multivisceral radical pelvic surgery is a technically feasible approach in well-selected patients resulting in symptom relief of > 90% of patients which covered almost 80% of the remaining life time. Palliative surgery needs to be considered more frequently iin the therapeutic armentarium of locally symptomatic CRPC. Adequate preoperative imaging studies, endoscopic evaluation and extensive surgical experience is mandatory to achieving a benefit for the individual patient with improvement of quality of life.