Catarino Raquel, Otta-Oshiro Renán Javier, Lista-Mateos Fernando, García-Mediero Jose María, Nunez-Mora Carlos
Urology Department, Pedro Hispano Hospital, Matosinhos, Spain.
Urology/Oncology Urology Department, MD Anderson Cancer Center, Madrid, Spain.
Cent European J Urol. 2022;75(1):59-64. doi: 10.5173/ceju.2022.0271. Epub 2022 Mar 24.
Treatment of radio-recurrent prostate cancer (PC) is managed mainly by androgen deprivation therapy. Nonetheless, selected patients could benefit from local salvage treatment options.In this study we present our series of recurrent PC cases submitted to laparoscopic salvage radical prostatectomy (sRP) at our institution.
A total of 29 patients with recurrent PC after primary non-surgical treatment were submitted to laparoscopic sRP at our institution, with a mean follow-up time of 7 years.
There were 7 post-operative complications Clavien-Dindo grade ≥2. At the end of the follow-up, 58.6% patients presented biochemical recurrence and five-year recurrence-free survival (RFS) was 50%.Positive lymph nodes, high preoperative prostate-specific antigen (PSA) and TNM stage were correlated with worse RFS. Cox regression analysis demonstrated that stage pT3b was independently associated with worse RFS in comparison with stage pT3a or less.At 12 months, pad-free continence or mild incontinence was observed in 62% of the patients.
sRP is a technically challenging surgery, and in our series, we were able to perform this procedure with acceptable operative time and limited blood loss.Post-operative complications, functional results and oncological outcomes were similar to other published studies, being our series, to the best of our knowledge, the one with the longest follow-up, of 7 years.sRP is a feasible local treatment with curative intent for radio-recurrent prostate cancer, with good oncological outcomes and reasonable continence rates in selected patients.
放射性复发性前列腺癌（PC）的治疗主要采用雄激素剥夺疗法。尽管如此，部分患者可能从局部挽救性治疗方案中获益。在本研究中，我们展示了在我们机构接受腹腔镜挽救性根治性前列腺切除术（sRP）的复发性PC病例系列。
共有29例在初次非手术治疗后复发的PC患者在我们机构接受了腹腔镜sRP，平均随访时间为7年。
有7例术后并发症，Clavien-Dindo分级≥2级。随访结束时，58.6%的患者出现生化复发，五年无复发生存率（RFS）为50%。阳性淋巴结、术前高前列腺特异性抗原（PSA）和TNM分期与较差的RFS相关。Cox回归分析表明，与pT3a期或更低分期相比，pT3b期与更差的RFS独立相关。在12个月时，62%的患者实现了无尿垫控尿或轻度尿失禁。
sRP是一项技术上具有挑战性的手术，在我们的系列研究中，我们能够在可接受的手术时间和有限失血情况下完成该手术。术后并发症、功能结果和肿瘤学结果与其他已发表的研究相似，据我们所知，我们的系列研究是随访时间最长（7年）的。sRP是一种对放射性复发性前列腺癌具有治愈意图的可行局部治疗方法，在选定患者中具有良好的肿瘤学结果和合理的控尿率。
