Department of Urology, University College London Hospital. NHS Foundation Trust. London. UK; Department of Urology, Onze Lieve Vrouw Hospital Aalst, Aalst, Belgium.
Department of Urology, University College London Hospital. NHS Foundation Trust. London. UK.
Eur Urol. 2020 Dec;78(6):885-892. doi: 10.1016/j.eururo.2020.05.003. Epub 2020 May 24.
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.
To report perioperative, functional and oncologic outcomes of sRARP in patients with localised PCa recurrence.
DESIGN, SETTING, AND PARTICIPANTS: We retrospectively evaluated 106 patients with local recurrence eligible for sRARP.
Surgery was performed using the DaVinci Si system similar to the standard approach but with adaptation to the primary treatment.
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.
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%.
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.
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.
挽救性机器人辅助根治性前列腺切除术（sRARP）已被描述为治疗原发性治疗后局部前列腺癌（PCa）复发的可行方法。然而，尚无大型报告发表癌症和质量结果。
报告局部 PCa 复发患者接受 sRARP 的围手术期、功能和肿瘤学结果。
设计、地点和参与者：我们回顾性评估了 106 名符合 sRARP 条件的局部复发患者。
手术使用达芬奇 Si 系统进行，类似于标准方法，但适应了原发性治疗。
围手术期结果包括 90 天并发症发生率。功能结果包括尿失禁和勃起功能障碍的发生率。肿瘤学结果包括肿瘤分期、切缘率和复发率。
原发性治疗是高强度聚焦超声（HIFU）的 59 例（56%）、放疗 27 例（25%）、种子近距离治疗 10 例（9%）、单独雄激素剥夺治疗（ADT）8 例（8%）、冷冻治疗 1 例（1%）和电穿孔/纳米刀 1 例（1%）。中位随访时间为 2.1 年。90 天并发症发生率为 8%。两年或以上时，50%的患者完全有节制，33%的患者有社交节制。局部治疗比全腺治疗后的节制率更高。勃起功能障碍发生率为 95%。切缘阳性率为 39%。生化复发率为 13%，局部或远处复发率为 11%。
sRARP 在技术上更具挑战性，但在高容量中心是治疗复发性 PCa 的可行选择。应告知患者，功能结果不如原发性 RARP。根据原发性治疗调整手术技术是获得良好手术结果的关键。
我们报告了我们在原发性治疗后局部 PCa 复发患者中使用 sRARP 的经验。这是一种可行的方法，具有可接受的围手术期并发症和癌症结果。功能结果不如原发性 RARP 好。
