Robotic salvage retropubic prostatectomy after radiation/brachytherapy: initial results

Abstract

OBJECTIVE To report on the initial four patients who had robotic salvage retropubic prostatectomy (SRP) for biochemical recurrence after radiation therapy, and to review the surgical outcome of robotic cystoprostatectomy for bladder cancer in two patients who previously had prostate cancer. PATIENTS AND METHODS Since February 2006, four patients had SRP for biochemical failure after radiation and/or brachytherapy. Transrectal biopsy of the prostate confirmed locally recurrent disease and a metastatic evaluation including bone scan and computed tomography of the abdomen and pelvis were negative in all cases. The SRP was done using a six‐port transperitoneal approach. An additional two patients had a robotic cystoprostatectomy for bladder cancer, in whom radiation was provided previously for prostate cancer. A retrospective analysis of the immediate and short‐term surgical outcome was reviewed. RESULTS SRP was completed in all patients with no major complication or conversion to an open approach. The mean operative duration was 125 min, the mean (range) blood loss was 117 (50–250) mL and the mean hospital stay was 2.7 days. Of the four patients undergoing SRP, three had extracapsular extension and the first two had positive margins, while no patients had rectal injuries or significant blood loss. The lymph nodes were negative in all the patients. Three patients were continent within a month while one continued to use two to three pads/day at 3 weeks of follow‐up. In the two patients who had cystoprostatectomy there were no major complications or increased surgical difficulty. CONCLUSIONS SRP is technically possible and with limited perioperative morbidity. Further studies are warranted to validate the oncological and functional outcomes of SRP after radiation and/or brachytherapy. Moreover, the robotic approach for radical cystoprostatectomy in patients who have had prostate radiation is feasible, with no increase in perioperative morbidity.

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

“…Kaouk et al [23] reported on the initial 4 patients who had SRARP for BCR after radiotherapy for PCa. Three patients were continent within a month while 1 continued to use 2-3 pads/day at 3-week follow-up.…”

“…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.…”

Revisión crítica del uso de radiación como tratamiento inicial del cáncer de próstata localizado

“…Además, existe un mayor riesgo de lesión rectal durante la PR en el territorio irradiado, que probablemente condenará al paciente a una colostomía definitiva. Incluso mediante abordajes laparoscópicos o robóticos, y aun siendo técnicamente factibles, se observa mayor morbilidad 12 . El problema se evidencia sobre todo en el perfil de paciente sano y con larga expectativa de vida, donde además de que la PR de rescate aumentará severamente la morbilidad, el resto de alternativas locales de rescate existentes (crioterapia, HIFU [High Intensity Focused Ultrasround]) no tienen ni un seguimiento ni una evidencia científica suficiente para ser recomendadas, y están expuestas a importante morbilidad cuando se aplican como rescate post-RT.…”

Salvage Therapy for Prostate Cancer: Which is Best? Brachytherapy versus Open and Robotic Prostatectomy

“…Treatment results could be improved if salvage therapy is considered very early in the disease process. SRARP is technically possible and with limited perioperative morbidity [18]. This curative therapy may be underutilized in biochemical recurrence [19].…”