Techniques and Outcomes of Salvage Robot-Assisted Radical Prostatectomy (sRARP).
Eur Urol
; 78(6): 885-892, 2020 12.
Article
em En
| MEDLINE
| ID: mdl-32461073
ABSTRACT
BACKGROUND:
Salvage Robot-Assisted Radical Prostatectomy (sRARP) has been described as feasible treatment for the management of localised prostate cancer (PCa) recurrence after primary treatment. However, no large reports have published cancer and quality outcomes.OBJECTIVE:
To report perioperative, functional and oncologic outcomes of sRARP in patients with localised PCa recurrence. DESIGN, SETTING, ANDPARTICIPANTS:
We retrospectively evaluated 106 patients with local recurrence eligible for sRARP. SURGICAL PROCEDURE Surgery was performed using the DaVinci Si system similar to the standard approach but with adaptation to the primary treatment. MEASUREMENTS Peri-operative outcomes included 90-day complication rate. Functional outcomes included rates of incontinence and erectile dysfunction. Oncological outcomes included tumour staging, margin rate and recurrence. RESULTS ANDLIMITATIONS:
Primary treatment was High Intensity Focused Ultrasound (HIFU) in 59 (56%) patients, 27 (25%) radiotherapy, 10 (9%) seed brachytherapy, 8 (8%) solitary androgen deprivation therapy (ADT), one (1%) cryotherapy and one (1%) electroporation / Nanoknife. Median follow-up was 2.1 years. 90-day complication rate was 8%. At two years or more, 50% were fully continent and 33% were socially continent. Continence rates tended to be better after focal compared to whole-gland treatments. Erectile dysfunction was present in 95%. Positive surgical margin rate was 39%. Biochemical recurrence occurred in 13% and local or metastatic recurrence in 11%.CONCLUSIONS:
sRARP is technically more challenging but is a feasible option in high-volume centres for treatment of recurrent PCa. Patients should be counselled that functional outcomes are inferior to primary RARP. Adjustment of surgical technique according to the primary treatment is key for good surgical outcomes. PATIENTSUMMARY:
We report our experience with sRARP for the management of localised PCa recurrence after primary treatment. This represents a feasible approach with acceptable peri-operative complications and cancer outcomes. Functional outcomes are inferior to RARP in the primary setting.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Prostatectomia
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Neoplasias da Próstata
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Terapia de Salvação
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Procedimentos Cirúrgicos Robóticos
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Recidiva Local de Neoplasia
Tipo de estudo:
Observational_studies
/
Risk_factors_studies
Limite:
Aged
/
Humans
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Male
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Middle aged
Idioma:
En
Revista:
Eur Urol
Ano de publicação:
2020
Tipo de documento:
Article