Evolution of Salvage Radical Prostatectomy from Open to Robotic and Further to Retzius Sparing Surgery.

Viktoria Schuetz,Joanne Nyarangi-Dix,Gencay Hatiboglu,Magdalena Goertz,Stefan Duensing,Svenja Dieffenbacher,Philipp Reimold,Markus Hohenfellner,Luisa Hofer

doi:10.3390/jcm11010202

Viktoria Schuetz, Joanne Nyarangi-Dix + Show 7 more

Open Access

https://doi.org/10.3390/jcm11010202

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Abstract

Salvage radical prostatectomy (sRP) has evolved from open to minimally invasive approaches. sRP can be offered to patients with local recurrence to improve biochemical recurrence (BCR)-free and overall survival. We evaluate oncological outcome and continence after retropubic (RRP), conventional (cRARP), and Retzius-sparing robotic (rsRARP) surgery. Materials/methods: A total of 53 patients undergoing sRP between 2010 and 2020 were included. Follow-up included oncological outcome and continence. Results: sRP was done as RRP (n = 25), cRARP (n = 7), or rsRARP (n = 21). Median blood loss was 900 mL, 500 mL, and 300 mL for RRP, cRARP, and rsRARP, respectively. At 12 months, 5 (20%), 0, and 4 (19%) patients were continent, 9 (36%), 3 (43%), and 7 (33%) had grade 1 incontinence, 5 (20%), 2 (29%), and 3 (14%) had grade 2 incontinence, and 3 (12%), 2 (29%), and 4 (19%) had grade 3 incontinence for RRP, cRARP, or rsRARP, respectively. During a mean follow-up of 52.6 months, 16 (64%), 4 (57%), and 3 (14%) developed BCR in the RRP-, cRARP-, and rsRARP-group, respectively. Conclusions: Over the years, sRP has shifted from open to laparoscopic/robotic surgery. RARP shows good oncological and functional outcome. rsRARP ensures direct vision on the rectum during preparation and can therefore increase safety and surgeon’s confidence, especially in the salvage setting.

Highlights

Prostate cancer (PCa) is the most common non-cutaneous cancer in men
For patients with histological proven local recurrence after primary radiation treatment (RT) or other organ preserving local treatments, salvage radical prostatectomy provides a curative option in well-selected cases [3] with intermediate term good cancer control [4] leading to biochemical recurrence (BCR)-free survival at 5 and 10 years of 47–82% and 28–53%, respectively [3]
Salvage prostatectomy was performed for local recurrence after primary external beam radiation therapy in 27 patients (50.9%), C12 ion irradiation therapy in 3 patients (5.7%), HIFU therapy in 14 patients (26.4%), HDR and LDR brachytherapy (1 patient (1.9%) and 6 patients (11.3%), respectively), and IRE and cryoablation in 1 patient (1.9%) each

Summary

Introduction

Prostate cancer (PCa) is the most common non-cutaneous cancer in men. The standard treatment for local prostate cancer includes radical prostatectomy (RP) or primary radiation treatment (RT) [1]. For patients with histological proven local recurrence after primary RT or other organ preserving local treatments, salvage radical prostatectomy (sRP) provides a curative option in well-selected cases [3] with intermediate term good cancer control [4] leading to BCR-free survival at 5 and 10 years of 47–82% and 28–53%, respectively [3]. SRP is not offered to all patients with regard to historic series due to high rates of procedure-related side effects [5]. Instead, these patients receive antihormonal, palliative treatment, missing the opportunity for a potential cure of their disease. Retropubic radical prostatectomy (RRP) as described by Walsh et al

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Conclusion