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Salvage robotic-assisted radical prostatectomy: oncologic and functional outcomes from two high-volume institutions

  • Gabriel Ogaya-Pinies
  • Estefania Linares-Espinos
  • Eduardo Hernandez-Cardona
  • Cathy Jenson
  • Xavier Cathelineau
  • Rafael Sanchez-Salas
  • Vipul Patel
Topic Paper
  • 15 Downloads

Abstract

Introduction

While no consensus on the optimal salvage treatment exists, only 3% of these patients will get salvage radical prostatectomies due to the assumed technical challenges of this procedure.

Objectives

Our goal is to analyze the perioperative, oncologic and functional outcomes of patients undergoing salvage robotic-assisted radical prostatectomy (sRARP) after primary treatment failure.

Materials and methods

Data were prospectively collected and retrospectively reviewed from a combined database of more than 14,800 patients who had undergone RARP. We identified 96 patients who underwent sRARP after RT or ablative techniques. Primary cancer characteristics, surgical data, pathology results, perioperative complications, oncologic and functional outcomes were analyzed.

Results

Sixty-eight patients (70.8%) received some source of RT as a primary treatment. The remaining 28 patients: 18 (18.75%) received cryotherapy, seven (7.92%) HIFU, one electroporation, one microwave and one Tookad. complication was seen in 25 (26%) patients (21 minor and 4 major complications). Anastomotic leak was the most common complication, found in 14 (14.6%) of the cases. No rectal injuries occurred. Fourteen (15%) patients had a biochemical failure after a median follow-up of 14 (IQR 5–24) months. Fifty-five (57.3%) of them self-reported to be pad-free at 12 months. Seventeen (55%) of 31 pre-operative potent patients (SHIM score > 21), were potent with or without the use of PDE5i at 12 months.

Conclusions

sRARP is a feasible alternative for PCa recurrence. Technically the procedure is challenging and should be performed by experienced PCa surgeons. Major complications are uncommon. Continence and potency recovery is possible, but at lower rates than for non-salvage patients.

Keywords

Salvage robotic-assisted radical prostatectomy (sRARP) Prostate cancer recurrence Radiotherapy Cryotherapy High-intesity focused ultrasound (HIFU) Brachyterapy Complications 

Notes

Author contributions

GOP project development, data analysis, manuscript writing. ELE data collection, data analysis, manuscript editing. EC data collection, manuscript writing. CJ manuscript writing and editing. XC project development, manuscript editing. RSS project development, data analysis, manuscript editing. VP project development, data analysis, manuscript editing.

Compliance with ethical standards

Conflict of interest

All authors have no conflict of interest to declare. This project includes human participants, but all procedures performed are within the regular clinical practice, no experimental procedures were performed and all the patients signed an informed consent before the treatment.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Gabriel Ogaya-Pinies
    • 1
  • Estefania Linares-Espinos
    • 2
  • Eduardo Hernandez-Cardona
    • 3
  • Cathy Jenson
    • 3
  • Xavier Cathelineau
    • 4
  • Rafael Sanchez-Salas
    • 4
  • Vipul Patel
    • 3
  1. 1.Hospital Universitario Rey Juan CarlosMostolesSpain
  2. 2.Hospital Universitario La PazMadridSpain
  3. 3.University of Central, Florida School of Medicine and Global Robotics InstituteFlorida Hospital-Celebration HealthCelebrationUSA
  4. 4.Institut Mutualiste MontsourisParisFrance

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