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; Coelho, Rafael F.; Liss, Michael A.; Rocco, Bernardo; Sivaraman, Ananthakrishnan; Palmer, Kenneth J.; Coughlin, Geoffrey; Ferrigni, Robert G.; Castle, Erik P.; Ahlering, Thomas E.; Parra-Davila, Eduard; Patel, Vipul

doi:10.1089/end.2010.0564

Cited by 41 publications

(56 citation statements)

References 23 publications

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“…Chauhan et al [24] identified 15 patients who underwent SRARP over a 20-month period. Median operative time, median estimated blood loss and median length of hospital stay were 140.5 min (range 97.5-157), 75 ml (range 50-100) and 1 day (range 1-2), respectively.…”

Section: Discussionmentioning

confidence: 99%

“…As more experience is being gained with robotic techniques, surgeons are expanding its application to more technically challenging procedures. In fact, recent case reports have described the feasibility of salvage RARP (SRARP), suggesting the robotic approach to be technically feasible, offering equivalent oncological outcomes and less convalescence than the open approach [20,21,22,23,24,25]. The objective of this study was to evaluate the surgical, oncological and functional outcomes in patients undergoing SRARP for the treatment of radiation-resistant PCa and to contribute our experience to the small amount of contemporary literature that exits on this topic.…”

Section: Introductionmentioning

confidence: 99%

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Robot-Assisted Radical Prostatectomy for the Treatment of Radiation-Resistant Prostate Cancer: Surgical, Oncological and Short-Term Functional Outcomes

et al. 2013

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Objective: The objective of this study was to assess the surgical, oncological and short-term functional outcomes in patients undergoing salvage robot-assisted radical prostatectomy (SRARP) for the treatment of radiation-resistant prostate cancer. Patients and Methods: The records of 3,500 men who underwent RARP from February 2006 to July 2011 were retrospectively reviewed. All peri- and postoperative data were recorded prospectively in our database. A total of 13 patients (0.37%) who had undergone SRARP for the treatment of radiation-resistant prostate cancer were identified. Results: The primary treatment was external beam radiotherapy in 7 patients (53.8%) and brachytherapy in 6 patients (46.2%). The interval from radiotherapy to biochemical recurrence (BCR) varied from 12 to 108 months (median 48.9). Neurovascular bundle preservation was performed in 3 patients (23.1%). No intraoperative or major complications were encountered. Minor complications were encountered in 4 patients (30.7%). At 12 months, 7 patients were continent (53.8%), 3 exhibited mild incontinence (23.1%) and 3 (23.1%) were incontinent. Regarding potency, none of the patients were potent at 6 months, but 3 patients (23.1%) were potent at 1 year. Regarding BCR, 3 of the patients (23.1%) never reached a prostate-specific antigen nadir of zero, and during the follow-up period only 3 patients (23.1%) exhibited BCR. No disease-specific mortality was evident during follow-up. Conclusions: Although early in its development, it appears that SRARP is technically feasible and offers satisfactory surgical, oncological and short-term functional outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Robot-Assisted Radical Prostatectomy for the Treatment of Radiation-Resistant Prostate Cancer: Surgical, Oncological and Short-Term Functional Outcomes

et al. 2013

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“…Since then, some authors highlighted some expedients in order to reduce the morbidity of sRARP. In the multi-institutional experience described by Chauhan et al, before performing the anastomosis, the integrity of the rectal wall was assessed in a similar three-step fashion: fi rst, an inspection of the rectal wall was performed under 10× magnifi cation and 3D vision of the da Vinci Surgical System; then the pelvic cavity was fi lled with normal saline while insuffl ating the rectal tube (the absence of bubbles signifi ed no major injuries); and fi nally, a fl exible sigmoidoscope was inserted into the rectum and the robotic camera light was turned off: any transilluminance suggested a thinning of the rectal wall [ 40 ]. In this 15-patient series, the median operative time, the median estimated blood loss, and the median length of hospital stay were 140.5 min, 75 ml, and 1 day, respectively.…”

Section: Salvage Rarpmentioning

confidence: 99%

Robot-Assisted Radical Prostatectomy

Rocco

Coelho

Cozzi

et al. 2014

Minimally Invasive Urology

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In the field of oncologic urologic surgery, robot-assisted radical prostatectomy (RARP) represents the main application of the robotic approach. RARP is currently the leading urologic use of the da Vinci system, and more than 80 % of the radical prostatectomies performed in the USA in 2011 were carried out by robot-assisted surgery. Indications for RARP are the same with those for radical retropubic prostatectomy (RRP), and RARP has also been described as a salvage surgical treatment after radiotherapy (RT), brachytherapy, and high-intensity focused ultrasound. Under an oncological point of view, RARP offers at least the same results of RRP also in higher-risk patients. Extended lymph node dissection yielding a reasonably high number of lymph nodes is feasible during RARP. The mean complication rate of RARP is 9 % (range, 3–26 %). Twelve-month urinary incontinence rates after RARP range from 4 to 31 %, with significant advantage in favor of RARP in comparison with RRP and laparoscopic radical prostatectomy. RARP is associated with an incidence of 12- and 24-month erectile dysfunction ranging from 10 to 46 % and from 6 to 37 %, respectively. A significant advantage in favor of RARP in comparison with RRP in terms of 12 months’ potency rates has been observed. Concomitant good oncological, continence, and potency outcomes define the concept of “trifecta.”\ud This chapter presents the technique for RARP described by Patel, which introduces some differences from the standard laparoscopic and robotic technique described previously

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“…[121314151617181920] Salvage robotic radical prostatectomy (sRRP) has shown promising early results and appears to be an excellent alternative to open SRP. As for any salvage procedure, prudent patient selection and surgical experience remain crucial for optimal perioperative and oncologic outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…[13141516171920] In our experience to date, sRRP has been safe and efficacious, with excellent early oncologic results, and has become our preferred method of performing SRP. The precision and dexterity of the robotic instrumentation combined with the superior visualization offered by the three-dimensional magnification of the operative field all facilitate the challenging aspects of the operation-namely, scarring and loss of tissue planes.…”

Section: Introductionmentioning

confidence: 99%

Salvage robotic radical prostatectomy

Kaffenberger¹,

Smith²

2014

Indian J Urol

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Failure of non-surgical primary treatment for localized prostate cancer is a common occurrence, with rates of disease recurrence ranging from 20% to 60%. In a large proportion of patients, disease recurrence is clinically localized and therefore potentially curable. Unfortunately, due to the complex and potentially morbid nature of salvage treatment, radical salvage surgery is uncommonly performed. In an attempt to decrease the morbidity of salvage therapy without sacrificing oncologic efficacy, a number of experienced centers have utilized robotic assistance to perform minimally invasive salvage radical prostatectomy. Herein, we critically evaluate the existing literature on salvage robotic radical prostatectomy with a focus on patient selection, perioperative complications and functional and early oncologic outcomes. These results are compared with contemporary and historical open salvage radical prostatectomy series and supplemented with insights we have gained from our experience with salvage robotic radical prostatectomy. The body of evidence by which conclusions regarding the efficacy and safety of robotic salvage radical prostatectomy can be drawn comprises fewer than 200 patients with limited follow-up. Preliminary results are promising and some outcomes have been favorable when compared with contemporary open salvage prostatectomy series. Advantages of the robotic platform in the performance of salvage radical prostatectomy include decreased blood loss, short length of stay and improved visualization. Greater experience is required to confirm the long-term oncologic efficacy and functional outcomes as well as the generalizability of results achieved at experienced centers.

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Preliminary Analysis of the Feasibility and Safety of Salvage Robot-Assisted Radical Prostatectomy After Radiation Failure: Multi-Institutional Perioperative and Short-Term Functional Outcomes

Abstract: 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.

Cited by 41 publications

References 23 publications

Robot-Assisted Radical Prostatectomy for the Treatment of Radiation-Resistant Prostate Cancer: Surgical, Oncological and Short-Term Functional Outcomes

Robot-Assisted Radical Prostatectomy for the Treatment of Radiation-Resistant Prostate Cancer: Surgical, Oncological and Short-Term Functional Outcomes

Robot-Assisted Radical Prostatectomy

Salvage robotic radical prostatectomy

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