381 SALVAGE ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY A SINGLE INSTITUTION FIVE-YEAR EXPERIENCE

Abstract

You have accessJournal of UrologyProstate Cancer: Localized I1 Apr 2012381 SALVAGE ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY A SINGLE INSTITUTION FIVE-YEAR EXPERIENCE Samuel D. Kaffenberger, Kirk A. Keegan, Todd M. Morgan, Neil K. Bansal, Dominic H. Tang, Daniel A. Barocas, David F. Penson, Rodney Davis, Peter E. Clark, Michael S. Cookson, S. Duke Herrell, and Joseph A. Smith Samuel D. KaffenbergerSamuel D. Kaffenberger Nashville, TN More articles by this author , Kirk A. KeeganKirk A. Keegan Nashville, TN More articles by this author , Todd M. MorganTodd M. Morgan Nashville, TN More articles by this author , Neil K. BansalNeil K. Bansal Nashville, TN More articles by this author , Dominic H. TangDominic H. Tang Nashville, TN More articles by this author , Daniel A. BarocasDaniel A. Barocas Nashville, TN More articles by this author , David F. PensonDavid F. Penson Nashville, TN More articles by this author , Rodney DavisRodney Davis Nashville, TN More articles by this author , Peter E. ClarkPeter E. Clark Nashville, TN More articles by this author , Michael S. CooksonMichael S. Cookson Nashville, TN More articles by this author , S. Duke HerrellS. Duke Herrell Nashville, TN More articles by this author , and Joseph A. SmithJoseph A. Smith Nashville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.444AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Salvage robotic-assisted laparoscopic prostatectomy (sRALP) is a feasible treatment option for certain patients with recurrent prostate cancer (CaP) after primary therapy; however, its use remains controversial. Data regarding patient selection, complication rates, and cancer outcomes are scarce. Here, we report the largest, single-institution series of sRALP. METHODS We evaluated 34 consecutive patients who underwent sRALP from 2006 to 2011. Initial treatment included: brachytherapy (BT) (n=14), external beam radiation therapy (XRT) (n=11), combined BT/XRT (n=5), and high-intensity focused ultrasound (n=4). Each patient had biopsy-proven recurrent CaP and no evidence of metastatic disease. The primary outcome measure was biochemical failure (BCF), which included both PSA persistence (PSA > 0.1ng/ml) and recurrence (PSA > 0.2ng/ml with confirmation) post-sRALP. Kaplan-Meier survival analysis was used to calculate freedom from BCF. (Figure). RESULTS The median age of the cohort was 66.5 years (interquartile range [IQR] 57.9-69.9 years). The median time from primary therapy to sRALP was 48.5 months (IQR 28.9-70.8 months) with a median PSA prior to sRALP of 3.86 ng/ml (IQR 2.41-5.07 ng/ml). Patients primarily had Gleason 6 (39%) and 7 (24%) disease on preoperative biopsy and most were clinical stage T1c (56%) and T2a ( 27%). Median time of surgery was 176 minutes (IQR 159-191 minutes) and 94% were discharged on the first post-operative day. There were two major complications: a pulmonary embolism (Clavien grade II) and a rectal laceration requiring repair and diversion (Clavien IIIb). 3 bladder neck contractures were managed with office dilation and 5 anastomotic leaks required prolonged catheterization. 27% of patients had positive margins, of which 33% had BCF following surgery. In all, 18% had BCF after a median follow-up of 16 months, and 44% have achieved urinary continence (0-1 pads per day). CONCLUSIONS sRALP appears to be safe, with outcomes favorable to open salvage radical prostatectomy series. Primary advantages are improved visualization of the posterior prostatic plane, low complication rates, and short length of stay. While initial results are promising, further follow-up is required to determine the long-term oncologic efficacy of this procedure. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e156 Advertisement Copyright & Permis