Comparative Outcomes of Salvage Retzius-Sparing Versus Standard Robotic Prostatectomy: An International, Multi-Surgeon Series.

MedStar author(s):
Citation: Journal of Urology. 206(5):1184-1191, 2021 11.PMID: 34181471Institution: MedStar Washington Hospital CenterDepartment: UrologyForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *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]Year: 2021Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0022-5347
Name of journal: The Journal of urologyAbstract: 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.All authors: Bocciardi AM, Eden CG, Fransis K, Galfano A, Hu JC, Hwang J, Jacobsohn K, Johnson S, Joniau S, Kim IY, Kowalczyk KJ, Madi RH, Raskin Y, Sooriakumaran POriginally published: Journal of Urology. :101097JU0000000000001939, 2021 Jun 28Fiscal year: FY2022Fiscal year of original publication: FY2021Digital Object Identifier: Date added to catalog: 2021-07-19
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 34181471 Available 34181471

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.

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