Covas Moschovas Marcio, Saikali Shady, Sandri Marco, Bravi Carlo, Falagario Ugo, Nathan Arjun, Collins Justin, Balestrazzi Eleonora, de Naeyer Gert, Groote Ruben, Chiara Sighinolfi Maria, Knipper Sophie, Graefen Markus, Pose Randi, Ploussard Guillaume, Idais Hamza, John Hubert, Mottaran Angelo, Schiavina Riccardo, Piazza Pietro, Brunocilla Eugenio, Breda Alberto, Rocco Bernardo, Harke Nina N, Mottrie Alexandre, Nathan Senthil, Patel Vipul, Wiklund Peter
Adventhealth Global Robotics Institute, Kissimmee, FL, USA.
Adventhealth Global Robotics Institute, Kissimmee, FL, USA.
Eur Urol. 2025 Jul;88(1):103-113. doi: 10.1016/j.eururo.2025.03.009. Epub 2025 Apr 10.
Salvage robotic-assisted radical prostatectomy (S-RARP) is one option for treating patients with recurrent prostate cancer after prostate-preserving primary therapy. However, the tissue damage, anatomical distortion, and lack of surgical landmarks caused by the primary treatment still constitute a major challenge to surgeons. We aim to report the experience of our group on S-RARP.
A retrospective multicentric study including data from nine centers from the European Association of Urology Robotic Urology Section Scientific Working Group was conducted. Overall, 397 patients who underwent S-RARP from 2008 to 2023 were included and divided into three groups (primary radiation therapy [RT], whole gland [WG] ablation, and focal gland [FG] ablation). The primary endpoints were the safety and feasibility of S-RARP. The secondary endpoints were the comparison of functional and oncological outcomes among different primary therapies.
The median (interquartile range) follow-up periods for RT, FG ablation, and WG ablation were 38 (19-73), 20 (10-37), and 24 (16-38) mo, respectively (p < 0.001). Only four patients (1%) had intraoperative complications and <2% had Clavien grade ≥3 after surgery. The 5-yr cumulative incidence rates of biochemical recurrence were 35%, 45%, and 23% for RT, FG ablation, and WG ablation, respectively (p = 0.3). The 3-yr cumulative incidence rates of continence were 67%, 92%, and 71% for RT, FG ablation, and WG ablation, respectively (p < 0.001). The 5-yr cumulative incidence rates of potency were 16%, 11%, and 5.3% (p = 0.2), while the overall survival rates at 5 yr were 95%, 94%, and 100% for RT, FG ablation, and WG ablation, respectively (p = 0.7).
S-RARP is safe and feasible with very low rates of perioperative complications. Functional outcomes in patients undergoing S-RARP are inferior to outcomes at primary surgery and demand highly skilled surgical expertise. Patients should be counseled carefully that the functional outcomes are inferior to those at primary surgery.
挽救性机器人辅助根治性前列腺切除术（S-RARP）是保留前列腺的初始治疗后复发性前列腺癌患者的一种治疗选择。然而，初始治疗造成的组织损伤、解剖结构变形以及手术标志的缺失，仍然给外科医生带来重大挑战。我们旨在报告我们团队开展S-RARP的经验。
进行了一项回顾性多中心研究，纳入了来自欧洲泌尿外科学会机器人泌尿外科分会科学工作组9个中心的数据。总体而言，纳入了2008年至2023年期间接受S-RARP的397例患者，并将其分为三组（初始放射治疗[RT]、全腺[WG]消融和局灶腺[FG]消融）。主要终点是S-RARP的安全性和可行性。次要终点是不同初始治疗之间功能和肿瘤学结局的比较。
RT、FG消融和WG消融的中位（四分位间距）随访期分别为38（19 - 73）、20（10 - 37）和24（16 - 38）个月（p < 0.001）。仅4例患者（1%）有术中并发症，术后Clavien分级≥3级的患者<2%。RT、FG消融和WG消融的5年生化复发累积发生率分别为35%、45%和23%（p = 0.3）。RT、FG消融和WG消融的3年控尿累积发生率分别为67%、92%和71%（p < 0.001）。5年性功能恢复累积发生率分别为16%、11%和5.3%（p = 0.2），而RT、FG消融和WG消融的5年总生存率分别为95%、94%和l00%（p = 0.7）。
S-RARP安全可行，围手术期并发症发生率极低。接受S-RARP患者的功能结局不如初次手术，需要高超的手术技巧。应仔细告知患者其功能结局不如初次手术。
