Hospital Universitario Rey Juan Carlos, C/Gladiolo s/n, 28933, Mostoles, Madrid, Spain.
Hospital Universitario La Paz, Madrid, Spain.
World J Urol. 2019 Aug;37(8):1499-1505. doi: 10.1007/s00345-018-2406-4. Epub 2018 Jul 13.
While no consensus on the optimal salvage treatment exists, only 3% of these patients will get salvage radical prostatectomies due to the assumed technical challenges of this procedure.
Our goal is to analyze the perioperative, oncologic and functional outcomes of patients undergoing salvage robotic-assisted radical prostatectomy (sRARP) after primary treatment failure.
Data were prospectively collected and retrospectively reviewed from a combined database of more than 14,800 patients who had undergone RARP. We identified 96 patients who underwent sRARP after RT or ablative techniques. Primary cancer characteristics, surgical data, pathology results, perioperative complications, oncologic and functional outcomes were analyzed.
Sixty-eight patients (70.8%) received some source of RT as a primary treatment. The remaining 28 patients: 18 (18.75%) received cryotherapy, seven (7.92%) HIFU, one electroporation, one microwave and one Tookad. complication was seen in 25 (26%) patients (21 minor and 4 major complications). Anastomotic leak was the most common complication, found in 14 (14.6%) of the cases. No rectal injuries occurred. Fourteen (15%) patients had a biochemical failure after a median follow-up of 14 (IQR 5-24) months. Fifty-five (57.3%) of them self-reported to be pad-free at 12 months. Seventeen (55%) of 31 pre-operative potent patients (SHIM score > 21), were potent with or without the use of PDE5i at 12 months.
sRARP is a feasible alternative for PCa recurrence. Technically the procedure is challenging and should be performed by experienced PCa surgeons. Major complications are uncommon. Continence and potency recovery is possible, but at lower rates than for non-salvage patients.
尽管对于最佳挽救性治疗尚无共识，但由于该手术的技术挑战，只有 3%的患者会接受挽救性根治性前列腺切除术。
我们的目标是分析初次治疗失败后行挽救性机器人辅助根治性前列腺切除术（sRARP）患者的围手术期、肿瘤学和功能结果。
从超过 14800 例接受 RARP 的患者的联合数据库中前瞻性收集并回顾性分析数据。我们确定了 96 例接受 RT 或消融技术后行 sRARP 的患者。分析了主要癌症特征、手术数据、病理结果、围手术期并发症、肿瘤学和功能结果。
68 例（70.8%）患者接受了某种形式的 RT 作为初始治疗。其余 28 例患者：18 例（18.75%）接受冷冻治疗，7 例（7.92%）接受高强度聚焦超声治疗，1 例接受电穿孔治疗，1 例接受微波治疗，1 例接受托卡德治疗。25 例（26%）患者出现并发症（21 例为轻微并发症，4 例为严重并发症）。吻合口漏是最常见的并发症，14 例（14.6%）患者发生。无直肠损伤发生。14 例（15%）患者在中位随访 14（IQR 5-24）个月后出现生化失败。55 例（57.3%）患者在 12 个月时无需使用尿垫。31 例术前有勃起功能障碍（SHIM 评分>21）的患者中，17 例（55%）在 12 个月时能够勃起，无论是否使用 PDE5i。
sRARP 是治疗前列腺癌复发的一种可行方法。该手术技术上具有挑战性，应由经验丰富的前列腺癌外科医生来进行。严重并发症并不常见。尿控和勃起功能恢复是可能的，但比率低于非挽救性患者。
