Comparative Outcomes of Salvage Retzius-Sparing Versus Standard Robotic Prostatectomy: An International, Multi-Surgeon Series.
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).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.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.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.
Authors: Keith J Kowalczyk, Rabii H Madi, Christopher G Eden, Prasanna Sooriakumaran, Karen Fransis, Yannic Raskin, Steven Joniau, Scott Johnson, Kenneth Jacobsohn, Antonio Galfano, Aldo M Bocciardi, Jonathan Hwang, Isaac Y Kim, Jim C Hu