Salvage Radical Prostatectomy for Recurrent Prostate Cancer: Morbidity and Functional Outcomes from a Large Multicenter Series of Open versus Robotic Approaches

No AccessJournal of UrologyAdult Urology1 Oct 2019Salvage Radical Prostatectomy for Recurrent Prostate Cancer: Morbidity and Functional Outcomes from a Large Multicenter Series of Open versus Robotic Approaches Paolo Gontero, Giancarlo Marra, Paolo Alessio, Claudia Filippini, Marco Oderda, Fernando Munoz, Estefania Linares, Rafael Sanchez-Salas, Ben Challacombe, Prokar Dasgupta, Sanchia Goonewardene, Rick Popert, Declan Cahill, David Gillatt, Raj Persad, Juan Palou, Steven Joniau, Thierry Piechaud, Alessandro Morlacco, Sharma Vidit, Morgan Rouprêt, Alexandre De La Taille, Simone Albisinni, Giorgio Gandaglia, Alexander Mottrie, Shreyas Joshi, Gabriel Fiscus, Andre Berger, Monish Aron, Henk Van Der Poel, Derya Tilki, Nathan Lawrentschuk, Declan G. Murphy, Gordon Leung, John Davis, Robert Jeffrey Karnes, Giorgio Calleris, Antonino Battaglia, Stefania Munegato, Anna Palazzetti, Francesca Pisano, Umberto Ricardi, Paul Cathcart, Salvatore Smelzo, Roland van Velthoven, Joseph Smith, Andre Abreu, and Inderbir S. Gill Paolo GonteroPaolo Gontero Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy , Giancarlo MarraGiancarlo Marra *Correspondence: Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, 10100Turin, Italy telephone: +39 011 6336451; FAX: +39 011 6335707; E-mail Address: [email protected] Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy , Paolo AlessioPaolo Alessio Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy , Claudia FilippiniClaudia Filippini Department of Statistics, University of Turin, Turin, Italy , Marco OderdaMarco Oderda Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy , Fernando MunozFernando Munoz Department of Radiotherapy, Parini Hospital, Aosta, Italy , Estefania LinaresEstefania Linares Department of Urology, Institut Mutualiste Montsouris, F-75013 Paris, France , Rafael Sanchez-SalasRafael Sanchez-Salas Department of Urology, Institut Mutualiste Montsouris, F-75013 Paris, France , Ben ChallacombeBen Challacombe Urology 47 Centre, Guy's Hospital, London, United Kingdom , Prokar DasguptaProkar Dasgupta Urology 47 Centre, Guy's Hospital, London, United Kingdom King's College London, London, United Kingdom , Sanchia GoonewardeneSanchia Goonewardene Urology 47 Centre, Guy's Hospital, London, United Kingdom , Rick PopertRick Popert Urology 47 Centre, Guy's Hospital, London, United Kingdom , Declan CahillDeclan Cahill Royal Marsden Hospital, London, United Kingdom , David GillattDavid Gillatt Bristol NHS Foundation Trust, Bristol, United Kingdom , Raj PersadRaj Persad Bristol NHS Foundation Trust, Bristol, United Kingdom , Juan PalouJuan Palou Fundaciò Puigvert, Barcelona, Spain , Steven JoniauSteven Joniau Leuven University Hospitals, Leuven, Belgium , Thierry PiechaudThierry Piechaud Clinique Saint Augustin, Bordeaux, France , Alessandro MorlaccoAlessandro Morlacco Mayo Clinic, Rochester, Minnesota , Sharma ViditSharma Vidit Mayo Clinic, Rochester, Minnesota , Morgan RouprêtMorgan Rouprêt Sorbonne Université, GRC No. 5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, F-75013 Paris, France , Alexandre De La TailleAlexandre De La Taille CHU Mondor, Créteil, France , Simone AlbisinniSimone Albisinni Institut Jules Bordet, Université Libre de Bruxelles, Bruxelles, Belgium , Giorgio GandagliaGiorgio Gandaglia OLV Hospital, Aalst, Belgium , Alexander MottrieAlexander Mottrie OLV Hospital, Aalst, Belgium , Shreyas JoshiShreyas Joshi Vanderbilt University, Medical Center North, Nashville, Tennessee , Gabriel FiscusGabriel Fiscus Vanderbilt University, Medical Center North, Nashville, Tennessee , Andre BergerAndre Berger USC Norris Comprehensive Cancer Center and Hospital, University of Southern California, California , Monish AronMonish Aron USC Norris Comprehensive Cancer Center and Hospital, University of Southern California, California , Henk Van Der PoelHenk Van Der Poel Netherlands Cancer Institute, Amsterdam, Netherlands , Derya TilkiDerya Tilki Martini-Klinik Prostate Cancer Center and Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany , Nathan LawrentschukNathan Lawrentschuk Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne and Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia , Declan G. MurphyDeclan G. Murphy Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne and Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia , Gordon LeungGordon Leung Division of Surgery, Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas , John DavisJohn Davis Division of Surgery, Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas , and Robert Jeffrey KarnesRobert Jeffrey Karnes Department of Oncology, University of Turin, Turin, Italy and Collaborators View All Author Informationhttps://doi.org/10.1097/JU.0000000000000327AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Salvage radical prostatectomy has historically yielded a poor functional outcome and a high complication rate. However, recent reports of robotic salvage radical prostatectomy have demonstrated improved results. In this study we assessed salvage radical prostatectomy functional outcomes and complications when comparing robotic and open approaches. Materials and Methods: We retrospectively collected data on salvage radical prostatectomy for recurrent prostate cancer after local nonsurgical treatment at 18 tertiary referral centers from 2000 to 2016. The Clavien-Dindo classification was applied to classify complications. Complications and functional outcomes were evaluated by univariable and multivariable analysis. Results: We included 395 salvage radical prostatectomies, of which 186 were open and 209 were robotic. Robotic salvage radical prostatectomy yielded lower blood loss and a shorter hospital stay (each p <0.0001). No significant difference emerged in the incidence of major and overall complications (10.1%, p=0.16, and 34.9%, p=0.67), including an overall low risk of rectal injury and fistula (1.58% and 2.02%, respectively). However, anastomotic stricture was more frequent for open salvage radical prostatectomy (16.57% vs 7.66%, p <0.01). Overall 24.6% of patients had had severe incontinence, defined as 3 or more pads per day, for 12 or 6 months. On multivariable analysis robotic salvage radical prostatectomy was an independent predictor of continence preservation (OR 0.411, 95% CI 0.232–0.727, p=0.022). Limitations include the retrospective nature of the study and the absence of a standardized surgical technique. Conclusions: In this contemporary series to our knowledge salvage radical prostatectomy showed a low risk of major complications and better functional outcomes than previously reported. Robotic salvage radical prostatectomy may reduce anastomotic stricture, blood loss and hospital stay, and improve continence outcomes. References 1. : Time trends and local variation in primary treatment of localized prostate cancer. J Clin Oncol 2010; 28: 1117. Google Scholar 2. : External irradiation with or without long-term androgen suppression for prostate cancer with high metastatic risk: 10-year results of an EORTC randomised study. Lancet Oncol 2010; 11: 1066. Google Scholar 3. : Post-treatment prostate biopsies in the era of three-dimensional conformal radiotherapy: what can they teach us?Eur Urol 2009; 55: 902. Google Scholar 4. : Radiorecurrent prostate cancer: an emerging and largely mismanaged epidemic. Eur Urol 2011; 60: 411. Google Scholar 5. : Getting the balance right-the benefits and uncertainties of focal therapy for significant prostate cancer. Eur Urol 2018; 74: 430. Google Scholar 6. : Focal therapy in primary localised prostate cancer: the European Association of Urology position in 2018. Eur Urol 2018; 74: 84. Google Scholar 7. : Focal therapy in localised prostate cancer: real-world urological perspective explored in a cross-sectional European survey. Urol Oncol 2018; 36: 529.e11. Google Scholar 8. : New and established technology in focal ablation of the prostate: a systematic review. Eur Urol 2017; 71: 17. Google Scholar 9. : Increasing prostate-specific antigen profile following definitive radiation therapy for localized prostate cancer: clinical observations. J Clin Oncol 1997; 15: 230. Google Scholar 10. : High dose rate (HDR) brachytherapy with conformal radiation therapy for localized prostate cancer. Eur Urol 2005; 47: 441. Google Scholar 11. : Complications, oncological and functional outcomes of salvage treatment options following focal therapy for localized prostate cancer: a systematic review and a comprehensive narrative review. World J Urol 2019. Google Scholar 12. : Comparisons of oncological and functional outcomes between primary whole-gland cryoablation and high-intensity focused ultrasound for localized prostate cancer. Ann Surg Oncol 2016; 23: 328. Google Scholar 13. : Cancer control and complications of salvage local therapy after failure of radiotherapy for prostate cancer: a systematic review. Semin Radiat Oncol 2013; 23: 222. Google Scholar 14. : Cancer control and functional outcomes of salvage radical prostatectomy for radiation-recurrent prostate cancer: a systematic review of the literature. Eur Urol 2012; 61: 961. Google Scholar 15. : Salvage robotic prostatectomy for radio recurrent prostate cancer: technical challenges and outcome analysis. Minerva Urol Nefrol 2017; 69: 26. Google Scholar 16. : Nerve-sparing in salvage robot-assisted prostatectomy: surgical technique, oncological and functional outcomes at a single high-volume institution. BJU Int 2018; 122: 837. Google Scholar 17. : Salvage robot assisted radical prostatectomy: a propensity matched study of perioperative, oncological and functional outcomes. Eur J Surg Oncol 2015; 41: 1540. Google Scholar 18. : Robot-assisted versus open radical prostatectomy: a contemporary analysis of an all-payer discharge database. Eur Urol 2016; 70: 837. Google Scholar 19. National Institute for Health and Care Excellence: Guidelines—Prostate Cancer. Available at https://www.nice.org.uk/guidance/conditions-and-diseases/cancer/prostate-cancer. Accessed January 9, 2018. Google Scholar 20. : Long-term oncologic results of salvage radical prostatectomy for locally recurrent prostate cancer after radiotherapy. Int J Radiat Oncol Biol Phys 2005; 62: 448. Google Scholar 21. : Robotic assisted laparoscopic salvage prostatectomy for radiation resistant prostate cancer. J Urol 2010; 183: 133. Link, Google Scholar 22. : Complications and outcomes of salvage robot-assisted radical prostatectomy: a single-institution experience. BJU Int 2014; 113: 769. Google Scholar 23. : Salvage radical prostatectomy for recurrent prostate cancer: verification of European Association of Urology guideline criteria. BJU Int 2016; 117: 55. Google Scholar 24. : Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol 2009; 55: 1037. Google Scholar 25. : Comparative oncologic and toxicity outcomes of salvage radical prostatectomy versus nonsurgical therapies for radiorecurrent prostate cancer: a meta-regression analysis. Eur Urol Focus 2016; 2: 158. Google Scholar 26. : All you need to know about urethrovesical anastomotic urinary leakage following radical prostatectomy. J Urol 2012; 188: 369. Link, Google Scholar 27. : Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet 2016; 388: 1057. Google Scholar 28. : Long-term side effects of androgen deprivation therapy in men with non-metastatic prostate cancer: a systematic literature review. Crit Rev Oncol Hematol 2006; 60: 201. Google Scholar 29. : Locally recurrent prostate cancer after initial radiation therapy: early salvage high-intensity focused ultrasound improves oncologic outcomes. Radiother Oncol 2012; 105: 198. Google Scholar 30. : Salvage prostate cryoablation: initial results from the cryo on-line data registry. J Urol 2008; 180: 559. Link, Google Scholar © 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByLeyh-Bannurah S, Liakos N, Oelke M, Wagner C, Schuette A, Fangmeyer B, Zinke J, Wasiri D, Mendrek M and Witt J (2021) Perioperative and Postoperative Outcomes of Robot-Assisted Radical Prostatectomy in Prostate Cancer Patients with Prior Transurethral Subvesical Deobstruction: Results of a High-Volume CenterJournal of Urology, VOL. 206, NO. 2, (308-318), Online publication date: 1-Aug-2021.Taneja S (2020) Re: Association of Presalvage Radiotherapy PSA Levels after Prostatectomy with Outcomes of Long-Term Antiandrogen Therapy in Men with Prostate CancerJournal of Urology, VOL. 204, NO. 5, (1096-1097), Online publication date: 1-Nov-2020.Smith J (2019) This Month in Adult UrologyJournal of Urology, VOL. 202, NO. 4, (631-632), Online publication date: 1-Oct-2019. Volume 202Issue 4October 2019Page: 725-731Supplementary Materials Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.Keywordslocalprostatic neoplasmsrobotic surgical proceduresneoplasm recurrencetreatment outcomeprostatectomyMetricsAuthor Information Paolo Gontero Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy More articles by this author Giancarlo Marra Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy *Correspondence: Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, 10100Turin, Italy telephone: +39 011 6336451; FAX: +39 011 6335707; E-mail Address: [email protected] More articles by this author Paolo Alessio Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy More articles by this author Claudia Filippini Department of Statistics, University of Turin, Turin, Italy More articles by this author Marco Oderda Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy More articles by this author Fernando Munoz Department of Radiotherapy, Parini Hospital, Aosta, Italy More articles by this author Estefania Linares Department of Urology, Institut Mutualiste Montsouris, F-75013 Paris, France More articles by this author Rafael Sanchez-Salas Department of Urology, Institut Mutualiste Montsouris, F-75013 Paris, France More articles by this author Ben Challacombe Urology 47 Centre, Guy's Hospital, London, United Kingdom More articles by this author Prokar Dasgupta Urology 47 Centre, Guy's Hospital, London, United Kingdom King's College London, London, United Kingdom More articles by this author Sanchia Goonewardene Urology 47 Centre, Guy's Hospital, London, United Kingdom More articles by this author Rick Popert Urology 47 Centre, Guy's Hospital, London, United Kingdom More articles by this author Declan Cahill Royal Marsden Hospital, London, United Kingdom More articles by this author David Gillatt Bristol NHS Foundation Trust, Bristol, United Kingdom More articles by this author Raj Persad Bristol NHS Foundation Trust, Bristol, United Kingdom More articles by this author Juan Palou Fundaciò Puigvert, Barcelona, Spain More articles by this author Steven Joniau Leuven University Hospitals, Leuven, Belgium More articles by this author Thierry Piechaud Clinique Saint Augustin, Bordeaux, France More articles by this author Alessandro Morlacco Mayo Clinic, Rochester, Minnesota More articles by this author Sharma Vidit Mayo Clinic, Rochester, Minnesota More articles by this author Morgan Rouprêt Sorbonne Université, GRC No. 5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, F-75013 Paris, France More articles by this author Alexandre De La Taille CHU Mondor, Créteil, France More articles by this author Simone Albisinni Institut Jules Bordet, Université Libre de Bruxelles, Bruxelles, Belgium More articles by this author Giorgio Gandaglia OLV Hospital, Aalst, Belgium More articles by this author Alexander Mottrie OLV Hospital, Aalst, Belgium More articles by this author Shreyas Joshi Vanderbilt University, Medical Center North, Nashville, Tennessee More articles by this author Gabriel Fiscus Vanderbilt University, Medical Center North, Nashville, Tennessee More articles by this author Andre Berger USC Norris Comprehensive Cancer Center and Hospital, University of Southern California, California More articles by this author Monish Aron USC Norris Comprehensive Cancer Center and Hospital, University of Southern California, California Financial interest and/or other relationship with Intuitive Surgical. More articles by this author Henk Van Der Poel Netherlands Cancer Institute, Amsterdam, Netherlands More articles by this author Derya Tilki Martini-Klinik Prostate Cancer Center and Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany More articles by this author Nathan Lawrentschuk Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne and Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia More articles by this author Declan G. Murphy Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne and Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia More articles by this author Gordon Leung Division of Surgery, Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas More articles by this author John Davis Division of Surgery, Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas Financial interest and/or other relationship with Intuitive Surgical. More articles by this author Robert Jeffrey Karnes Department of Oncology, University of Turin, Turin, Italy More articles by this author Expand All Advertisement Loading ...