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Outcomes of Salvage Robotic-assisted Radical Prostatectomy: High-volume Multicentric Data from the European
Marcio Covas Moschovas1, Shady Saikali1, Marco Sandri2
1Adventhealth Global Robotics Institute, Kissimmee, FL, USA.
Background And Objective:
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.
Methods And Surgical Procedure:
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.
Key Findings And Limitations:
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).
Conclusions:
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.
