Oncological outcomes and complications after salvage robotic-assisted laparoscopic radical prostatectomy (sRALP)
DOI:
https://doi.org/10.2340/sju.v60.44585Keywords:
Radiorecurrent prostate cancer, salvage robotic-assisted prostatectomy, PSA persistence, biochemical recurrenceAbstract
Objective: To evaluate oncological and functional outcomes after salvage robotic-assisted laparoscopic radical prostatectomy (sRALP).
Material and methods: We included 60 patients, consecutively treated with sRALP for radiorecurrent prostate cancer (PCa) at Oslo University Hospital (OUS). Data were collected from our PCa registry and electronic patient journal (EPJ). PSA persistence was defined as PSA ≥ 0.1 ng/mL 6 weeks postoperatively, and these patients were not included in the survival analysis. Logistic regression was used to find variables associated with PSA persistence. Biochemical recurrence (BCR) was defined as PSA ≥ 0.2 ng/mL. Cox regression was used to analyse BCR-free survival. Urinary leakage was graded as minor, moderate or severe. Complications were classified according to the Clavien-Dindo classification.
Results: Twenty-three patients (38%) had persistent PSA. With a median follow-up of 82 months (interquartile range [IQR] 48–101 months), 16 patients (28%) had no BCR or start of androgen deprivation therapy (ADT). Twelve patients (20%) were deceased, 10 (17%) from PCa.
Preoperative PSA was statistically significantly associated with persistent PSA (p = 0.01). International Society of Urological Pathology (ISUP) Grade Group 5 showed a statistically significant association with BCR (p = 0.01). Anastomosis leakage and strictures occurred in 27 (45%) and 15 patients (33%), respectively. Twenty-nine patients (48%) suffered severe urinary leakage, whilst 11 patients (24%) had moderate urinary leakage. Eleven patients (18%) received artificial urinary sphincters, and 10 patients (17%) underwent urinary diversion. Two patients suffered a grade 4 complication (sepsis), whilst 25 patients (41%) had grade 3 complications, most of which were related to intervention in the urinary system.
Conclusion: Salvage RALP for radiorecurrent PCa has limited effect on oncological outcomes. Patients should be thoroughly informed about the high risk of urinary leakage and severe surgical complications.
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