Comparative Outcomes of Salvage Retzius-Sparing Versus Standard Robotic Prostatectomy: An International, Multi-Surgeon Series.
Comparative Outcomes of Salvage Retzius-Sparing Versus Standard Robotic Prostatectomy: An International, Multi-Surgeon Series.
- 2021
Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
CONCLUSION: SRS-RARP is a feasible salvage option with significantly improved urinary function outcomes. This may warrant increased utilization of SRS-RARP to manage men who fail non-surgical primary treatment for prostate cancer. INTRODUCTION: Salvage prostatectomy (SRP) is rare due to the risk of postoperative complications. We compare salvage Retzius-sparing robotic-assisted radical prostatectomy (SRS-RARP) with salvage standard robotic-assisted radical prostatectomy (SS-RARP). MATERIALS AND METHODS: 72 patients across 9 centers were identified (40 SRS-RARP vs. 32 SS-RARP). Demographics, perioperative data, and pathologic and functional outcomes were compared using student's t-test and ANOVA. Cox proportional hazard models and Kaplan-Meier curves were constructed to assess risk of incontinence and time to continence. Linear regression models were constructed to investigate postoperative pad use and console time. RESULTS: Median follow-up was 23 vs. 36 months for SRS-RARP vs. SS-RARP. Console time and EBL favored SRS-RARP. There were no differences in complication rates or oncologic outcomes. SRS-RARP had improved continence (78.4% vs. 43.8%, p <0.001 for 0-1 pad, 54.1% vs. 6.3%, p <0.001 for 0 pad), lower pads per day (0.57 vs. 2.03, p <0.001), and earlier return to continence (median 47 vs. 180 days, p=0.008). SRS-RARP was associated with decreased incontinence defined as >0-1 pad (HR 0.36, 95% CI 0.15-0.89, p=0.028), although not when defined as >0 pad (HR 0.56, 95% CI 0.31-1.01, p=0.053). On adjusted analysis SRS-RARP was associated with decreased pad per day. Lymph node dissection and primary treatment with SBRT were associated with longer console time.
English
0022-5347
10.1097/JU.0000000000001939 [doi]
*Organ Sparing Treatments/ae [Adverse Effects]
*Postoperative Complications/ep [Epidemiology]
*Prostatectomy/ae [Adverse Effects]
*Prostatic Neoplasms/su [Surgery]
*Robotic Surgical Procedures/ae [Adverse Effects]
*Salvage Therapy/ae [Adverse Effects]
*Urinary Incontinence/ep [Epidemiology]
Aged
Feasibility Studies
Humans
Incontinence Pads/sn [Statistics & Numerical Data]
Male
Middle Aged
Organ Sparing Treatments/mt [Methods]
Organ Sparing Treatments/sn [Statistics & Numerical Data]
Postoperative Complications/et [Etiology]
Postoperative Complications/th [Therapy]
Prostate/pa [Pathology]
Prostate/su [Surgery]
Prostatectomy/mt [Methods]
Prostatectomy/sn [Statistics & Numerical Data]
Retrospective Studies
Risk Assessment/sn [Statistics & Numerical Data]
Robotic Surgical Procedures/sn [Statistics & Numerical Data]
Salvage Therapy/mt [Methods]
Salvage Therapy/sn [Statistics & Numerical Data]
Time Factors
Treatment Outcome
Urinary Incontinence/et [Etiology]
Urinary Incontinence/th [Therapy]
MedStar Washington Hospital Center
Urology
Journal Article
Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
CONCLUSION: SRS-RARP is a feasible salvage option with significantly improved urinary function outcomes. This may warrant increased utilization of SRS-RARP to manage men who fail non-surgical primary treatment for prostate cancer. INTRODUCTION: Salvage prostatectomy (SRP) is rare due to the risk of postoperative complications. We compare salvage Retzius-sparing robotic-assisted radical prostatectomy (SRS-RARP) with salvage standard robotic-assisted radical prostatectomy (SS-RARP). MATERIALS AND METHODS: 72 patients across 9 centers were identified (40 SRS-RARP vs. 32 SS-RARP). Demographics, perioperative data, and pathologic and functional outcomes were compared using student's t-test and ANOVA. Cox proportional hazard models and Kaplan-Meier curves were constructed to assess risk of incontinence and time to continence. Linear regression models were constructed to investigate postoperative pad use and console time. RESULTS: Median follow-up was 23 vs. 36 months for SRS-RARP vs. SS-RARP. Console time and EBL favored SRS-RARP. There were no differences in complication rates or oncologic outcomes. SRS-RARP had improved continence (78.4% vs. 43.8%, p <0.001 for 0-1 pad, 54.1% vs. 6.3%, p <0.001 for 0 pad), lower pads per day (0.57 vs. 2.03, p <0.001), and earlier return to continence (median 47 vs. 180 days, p=0.008). SRS-RARP was associated with decreased incontinence defined as >0-1 pad (HR 0.36, 95% CI 0.15-0.89, p=0.028), although not when defined as >0 pad (HR 0.56, 95% CI 0.31-1.01, p=0.053). On adjusted analysis SRS-RARP was associated with decreased pad per day. Lymph node dissection and primary treatment with SBRT were associated with longer console time.
English
0022-5347
10.1097/JU.0000000000001939 [doi]
*Organ Sparing Treatments/ae [Adverse Effects]
*Postoperative Complications/ep [Epidemiology]
*Prostatectomy/ae [Adverse Effects]
*Prostatic Neoplasms/su [Surgery]
*Robotic Surgical Procedures/ae [Adverse Effects]
*Salvage Therapy/ae [Adverse Effects]
*Urinary Incontinence/ep [Epidemiology]
Aged
Feasibility Studies
Humans
Incontinence Pads/sn [Statistics & Numerical Data]
Male
Middle Aged
Organ Sparing Treatments/mt [Methods]
Organ Sparing Treatments/sn [Statistics & Numerical Data]
Postoperative Complications/et [Etiology]
Postoperative Complications/th [Therapy]
Prostate/pa [Pathology]
Prostate/su [Surgery]
Prostatectomy/mt [Methods]
Prostatectomy/sn [Statistics & Numerical Data]
Retrospective Studies
Risk Assessment/sn [Statistics & Numerical Data]
Robotic Surgical Procedures/sn [Statistics & Numerical Data]
Salvage Therapy/mt [Methods]
Salvage Therapy/sn [Statistics & Numerical Data]
Time Factors
Treatment Outcome
Urinary Incontinence/et [Etiology]
Urinary Incontinence/th [Therapy]
MedStar Washington Hospital Center
Urology
Journal Article