City of Hope National Cancer Center, Urology, Duarte, CA, USA.
BJU Int. 2014 May;113(5):769-76. doi: 10.1111/bju.12595.
To determine the peri-operative outcomes of men undergoing salvage robot-assisted prostatectomy (RARP) and to examine the complications, functional consequences and need for additional treatments after salvage RARP.
At total of 51 consecutive patients underwent salvage RARP after previous failed local therapy. Biochemical recurrence (BCR) was defined as two postoperative PSA measurements ≥0.2 ng/mL. Complications at any time postoperatively were recorded prospectively using a modified Clavien system. The Kaplan-Meier method was used for survival estimation, and regression models were used to identify the predictors of BCR or progression-free survival (PFS) and complications.
The median age at salvage RARP was 68 years and a median of 68 months had elapsed from the time of primary treatment. The median follow-up was 36 months. The median operation duration was 179 min with a median estimated blood loss of 175 mL. In all, 50% of patients had pathological stage 3 disease and positive surgical margins were found in 31% of patients. The estimated 3-year BCR-free or PFS was 57%. The overall complication rate was 47%, with a 35% major complication rate (Grade III-V). Potency was maintained in 23% of preoperatively potent patients and 45% of all patients regained urinary control. No clinical variables were predictive of major complications, but all patients with postoperative bladder neck contracture were incontinent. A higher PSA level and extracapsular extension were significantly associated with BCR or progression (P < 0.01).
Salvage RARP provides oncological control with potential avoidance of systemic non-curative therapy. Complication, incontinence and erectile dysfunction rates are significant but frequently correctable. This reinforces the need for proper patient counselling and selection.
确定接受挽救性机器人辅助前列腺切除术（RARP）的男性的围手术期结果，并检查挽救性 RARP 后的并发症、功能后果和需要额外治疗的情况。
共有 51 例连续患者在先前局部治疗失败后接受了挽救性 RARP。生化复发（BCR）定义为两次术后 PSA 测量值≥0.2ng/mL。术后任何时间的并发症均使用改良的 Clavien 系统前瞻性记录。Kaplan-Meier 法用于生存估计，回归模型用于识别 BCR 或无进展生存期（PFS）和并发症的预测因素。
挽救性 RARP 的中位年龄为 68 岁，从初次治疗到挽救性 RARP 的中位时间为 68 个月。中位随访时间为 36 个月。中位手术时间为 179 分钟，中位估计失血量为 175 毫升。所有患者中有 50%为病理分期 3 期疾病，31%的患者发现阳性手术切缘。估计 3 年 BCR 无复发或 PFS 为 57%。总的并发症发生率为 47%，其中 35%为严重并发症（III-V 级）。23%的术前有勃起功能的患者保持勃起功能，45%的所有患者恢复尿控。没有临床变量可预测严重并发症，但所有术后膀胱颈挛缩的患者均失禁。较高的 PSA 水平和包膜外延伸与 BCR 或进展显著相关（P<0.01）。
挽救性 RARP 可提供肿瘤控制，并有潜力避免全身非治愈性治疗。并发症、尿失禁和勃起功能障碍的发生率较高，但通常是可纠正的。这进一步强调了对患者进行适当咨询和选择的必要性。
