Preliminary analysis of the feasibility and safety of salvage robot-assisted radical prostatectomy after radiation failure: Multi-institutional perioperative and short-term functional outcomes

Chauhan, Sanket, Patel, Manoj B., Coelho, Rafael, Liss, Michael, Rocco, Bernardo, Sivaraman, Ananth K., Palmer, Kenneth J., Coughlin, Geoffrey D., Ferrigni, Robert G., Castle, Erik P., Ahlering, Thomas E., Parra-Davila, Eduard and Patel, Vipul R. (2011) Preliminary analysis of the feasibility and safety of salvage robot-assisted radical prostatectomy after radiation failure: Multi-institutional perioperative and short-term functional outcomes. Journal of Endourology, 25 6: 1013-1019. doi:10.1089/end.2010.0564


Author Chauhan, Sanket
Patel, Manoj B.
Coelho, Rafael
Liss, Michael
Rocco, Bernardo
Sivaraman, Ananth K.
Palmer, Kenneth J.
Coughlin, Geoffrey D.
Ferrigni, Robert G.
Castle, Erik P.
Ahlering, Thomas E.
Parra-Davila, Eduard
Patel, Vipul R.
Title Preliminary analysis of the feasibility and safety of salvage robot-assisted radical prostatectomy after radiation failure: Multi-institutional perioperative and short-term functional outcomes
Journal name Journal of Endourology   Check publisher's open access policy
ISSN 0892-7790
1557-900X
Publication date 2011-06
Sub-type Article (original research)
DOI 10.1089/end.2010.0564
Volume 25
Issue 6
Start page 1013
End page 1019
Total pages 7
Place of publication New Rochelle, NY, United States
Publisher Mary Ann Liebert, Inc. Publishers
Collection year 2012
Language eng
Formatted abstract
Background and Purpose:
Open radical prostatectomy after radiation treatment failure for prostate cancer is associated with significant morbidity. The purpose of the study is to report multi-institutional experiences while performing salvage robot-assisted radical prostatectomy (sRARP).

Patients and Methods:
We retrospectively identified 15 patients with biopsy-proven prostate cancer after definitive radiotherapy who underwent sRARP in three academic institutions over a 20-month period. Continence was defined as the use of 0 pads after surgery. Potency was defined as the ability to achieve erections adequate enough for penetration with or without the use of phosphodiesterase-5 inhibitors. Biochemical recurrence after sRARP was defined as a prostate-specific antigen value of >0.2 ng/mL.

Results:
Radiation treatment consisted of external-beam radiation therapy (XRT) in five cases, interstitial radioactive 125-iodine brachytherapy (BT) in five cases, proton beam therapy in two cases, and XRT followed by interstitial radioactive 125-iodine BT in three cases. The median operative time, the median estimated blood loss, and the median length of hospital stay were 140.5 min (interquartile range [IQR] 97.5-157 min), 75 mL (IQR 50-100 mL), and 1 day (IQR 1-2 d), respectively. There were no rectal injuries. Two (13.3%) patients had a positive surgical margin. A total of three (20%) patients had postoperative complications. One patient had a deep vein thrombosis (Clavien grade II), one had wound infection (Clavien grade II), and one patient had an anastomotic leak (Clavien gradeId). An anastomotic stricture (Clavien grade IIIa) later developed in this same patient, which was managed by direct visual internal urethrotomy. Of the patients, 71.4% were continent. At a median follow-up of 4.6 months (IQR 3-9.75 mos), four (28.6%) patients presented with biochemical recurrence after sRARP.

Conclusions:

The challenge during sRALP is the presence of extensive fibrosis and loss of dissection planes secondary to radiation therapy. It is a technically challenging but feasible procedure. The early complication rates were low, and early continence rates are encouraging.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status Non-UQ
Additional Notes Online Ahead of Print: May 13, 2011.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Non HERDC
School of Medicine Publications
 
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Created: Thu, 08 Dec 2011, 13:48:37 EST by Matthew Lamb on behalf of School of Medicine