Department of Urology, MedStar Georgetown University Hospital and Washington Hospital Center, Lombardi Cancer Center, Washington, District of Columbia.
Section of Urology, Department of Surgery, Medical College of Georgia-Augusta University, Georgia Cancer Center, Augusta, Georgia.
J Urol. 2021 Nov;206(5):1184-1191. doi: 10.1097/JU.0000000000001939. Epub 2021 Jun 28.
Salvage radical prostatectomy is rare due to the risk of postoperative complications. We compare salvage Retzius-sparing robotic assisted radical prostatectomy (SRS-RARP) with salvage standard robotic assisted radical prostatectomy (SS-RARP).
A total of 72 patients across 9 centers were identified (40 SRS-RARP vs 32 SS-RARP). Demographics, perioperative data, and pathological and functional outcomes were compared using Student's t-test and ANOVA. Cox proportional hazard models and Kaplan-Meier curves were constructed to assess risk of incontinence and time to continence. Linear regression models were constructed to investigate postoperative pad use and console time.
Median followup was 23 vs 36 months for SRS-RARP vs SS-RARP. Console time and estimated blood loss favored SRS-RARP. There were no differences in complication rates or oncologic outcomes. SRS-RARP had improved continence (78.4% vs 43.8%, p <0.001 for 0-1 pad, 54.1% vs 6.3%, p <0.001 for 0 pad), lower pads per day (0.57 vs 2.03, p <0.001), and earlier return to continence (median 47 vs 180 days, p=0.008). SRS-RARP was associated with decreased incontinence defined as >0-1 pad (HR 0.28, 95% CI 0.10-0.79, p=0.016), although not when defined as >0 pad (HR 0.56, 95% CI 0.31-1.01, p=0.053). On adjusted analysis SRS-RARP was associated with decreased pads per day. Lymph node dissection and primary treatment with stereotactic body radiation therapy were associated with longer console time.
SRS-RARP is a feasible salvage option with significantly improved urinary function outcomes. This may warrant increased utilization of SRS-RARP to manage men who fail nonsurgical primary treatment for prostate cancer.
由于术后并发症的风险，挽救性根治性前列腺切除术很少见。我们比较了挽救性保留耻骨后间隙的机器人辅助根治性前列腺切除术（SRS-RARP）与挽救性标准机器人辅助根治性前列腺切除术（SS-RARP）。
共在 9 个中心确定了 72 例患者（40 例 SRS-RARP 与 32 例 SS-RARP）。使用学生 t 检验和方差分析比较了人口统计学、围手术期数据以及病理和功能结果。构建 Cox 比例风险模型和 Kaplan-Meier 曲线以评估尿失禁风险和达到控尿的时间。构建线性回归模型以研究术后使用尿垫和控制台时间。
SRS-RARP 与 SS-RARP 的中位随访时间分别为 23 个月和 36 个月。控制台时间和估计失血量有利于 SRS-RARP。并发症发生率或肿瘤学结果无差异。SRS-RARP 的尿控改善（0-1 片尿垫组为 78.4%比 43.8%，p<0.001；0 片尿垫组为 54.1%比 6.3%，p<0.001）、尿垫日使用量减少（0.57 片比 2.03 片，p<0.001）、控尿时间更早（中位数 47 天比 180 天，p=0.008）。SRS-RARP 与定义为 >0-1 片尿垫的失禁减少相关（HR 0.28，95%CI 0.10-0.79，p=0.016），但与定义为 >0 片尿垫的失禁减少无关（HR 0.56，95%CI 0.31-1.01，p=0.053）。在调整分析中，SRS-RARP 与尿垫日使用量减少相关。淋巴结清扫和立体定向体部放射治疗的原发性治疗与控制台时间延长相关。
SRS-RARP 是一种可行的挽救性选择，其尿功能结局显著改善。这可能需要增加 SRS-RARP 的应用，以治疗非手术性原发性前列腺癌治疗失败的男性。
