Evolution of Salvage Radical Prostatectomy from Open to Robotic and Further to Retzius Sparing Surgery

Abstract

Salvage radical prostatectomy (sRP) has evolved from open to minimally invasive approaches. sRP can be offered to patients with local recurrence to improve biochemical recurrence (BCR)-free and overall survival. We evaluate oncological outcome and continence after retropubic (RRP), conventional (cRARP), and Retzius-sparing robotic (rsRARP) surgery. Materials/methods: A total of 53 patients undergoing sRP between 2010 and 2020 were included. Follow-up included oncological outcome and continence. Results: sRP was done as RRP (n = 25), cRARP (n = 7), or rsRARP (n = 21). Median blood loss was 900 mL, 500 mL, and 300 mL for RRP, cRARP, and rsRARP, respectively. At 12 months, 5 (20%), 0, and 4 (19%) patients were continent, 9 (36%), 3 (43%), and 7 (33%) had grade 1 incontinence, 5 (20%), 2 (29%), and 3 (14%) had grade 2 incontinence, and 3 (12%), 2 (29%), and 4 (19%) had grade 3 incontinence for RRP, cRARP, or rsRARP, respectively. During a mean follow-up of 52.6 months, 16 (64%), 4 (57%), and 3 (14%) developed BCR in the RRP-, cRARP-, and rsRARP-group, respectively. Conclusions: Over the years, sRP has shifted from open to laparoscopic/robotic surgery. RARP shows good oncological and functional outcome. rsRARP ensures direct vision on the rectum during preparation and can therefore increase safety and surgeon’s confidence, especially in the salvage setting.

Salvage Retzius-Sparing Radical Prostatectomy: A Review of Complications, Functional Outcomes, and Oncologic Outcomes

“…These values were taken on biopsy after initial treatment. Schuetz et al [ 20 ] reported initial GG prior to index treatment, thus, these were not included. In terms of initial treatments, patients most frequently underwent external beam radiation therapy (EBRT) in both groups (52% vs. 49%).…”

“…Cryoablation was not common with 2% of SRS and 13% of SS patients choosing this modality. Other treatments were quite rare (4% vs. 2%), with the most common being C-12 ion ablation, used exclusively in the Schuetz et al [ 20 ] series. There were no significant differences between initial treatments in any study.…”

“…Nerve-sparing approaches were done in 27% (22/81) of patients who underwent SRS and 31% (14/45) of patients who underwent SS. Notably, this was not performed in most cases of Schuetz et al [ 20 ] due to oncologic concerns and tissue fibrosis from prior radiation. Most of the patients who underwent nerve-sparing were reported in the Kowalczyk et al [ 21 ] series (19/81 and 14/45).…”

“…30-day complications were lower in the SRS group (10%, 6/60) vs. the SS group (26%, 10/39), though this was not significantly different in any study. There was one rectal injury reported in all patients, seen in the SS cohort of Schuetz et al [ 20 ] There was one death within 30 days from cardiac complications in Kowalczyk et al [ 21 ] Mean length of stay was reported in the Schuetz et al [ 20 ] study at 5.7 and 5.4 days and 1 day and 1 day in Madi et al [ 19 ] for SRS and SS, respectively.…”

“…All were retrospective studies comparing SRS to salvage standard radical prostatectomy (SS). Schuetz et al [ 20 ] was a retrospective study of all patients who underwent salvage RARP at a single institution while Madi et al [ 19 ] was a non-randomized prospectively maintained database of cases, studied retrospectively. Kowalczyk et al [ 21 ] was a multicenter, retrospective study of patients who underwent RARP in the salvage setting with either SRS or SS.…”