Techniques and Outcomes of Salvage Robot-Assisted Radical Prostatectomy (sRARP)

Groote, Ruben De; Nathan, Arjun; Bleser, Elise De; Pavan, Nicola; Sridhar, Ashwin; Kelly, John D.; Sooriakumaran, Prasanna; Briggs, T.; Nathan, Senthil

doi:10.1016/j.eururo.2020.05.003

Cited by 27 publications

(28 citation statements)

References 16 publications

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“…Furthermore, early potency rates post RARP can be as low as 33% during the 6-month follow-up period [ 4 ]. Salvage RARP has shown inferior Erectile Function (EF] outcomes compared to primary RARP with only 5% maintaining their pre-operative EF with two-year follow-up [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Immediate post-operative PDE5i therapy improves early erectile function outcomes after robot assisted radical prostatectomy (RARP)

et al. 2021

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To assess whether the timing of post-operative Phosphodiesterase Inhibitor (PDE5i) therapy after Robot-Assisted Radical Prostatectomy (RARP) is associated with a change in early erectile function (EF) outcomes, continence or safety outcomes. Data were prospectively collected from a single surgeon in one tertiary centre. 158 patients were treated with PDE5i therapy post RARP over a 2-year period. PDE5i therapy was started: immediately (day 1–2) post-op in 29%, early (day 3–14) post-op in 37% and late (after day 14) post-op in 34%. EPIC-26 EF scores were collected pre-op and post-op. There were no significant differences in pre-operative characteristics between the therapy groups. Drop in EF scores and percentage return to baseline for unilateral nerve sparing was, respectively, 9 and 11.1% of immediate therapy, 7 and 14.8% of early therapy and 9.7 and 9.5% of late therapy (p = 0.9 and p = 0.6). For bilateral nerve sparing, this was, respectively, 3.5 and 42.9% immediate therapy, 5.5 and 35.5% early therapy and 7.3 and 25% late therapy (p = 0.017 and p = 0.045). Pad free and social continence were achieved in 54% and 37% of those receiving immediate therapy, 60% and 33% for early therapy and 26% and 54% for late therapy. There were no differences in compliance, complication or readmission outcomes. In patients with bilateral nerve sparing RARP, immediate post-operative PDE5i therapy can protect EF and improve early continence outcomes. Therefore, immediate PDE5i therapy should be considered in patients following nerve sparing RARP to maximise functional outcomes.

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Section: Introductionmentioning

confidence: 99%

Immediate post-operative PDE5i therapy improves early erectile function outcomes after robot assisted radical prostatectomy (RARP)

et al. 2021

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“…The major concern after sRARP has primarily been a high risk of post-surgical incontinence as well as high complication rates reported in early surgical series [ 15 – 17 ]. This is also seen in our study with considerable incontinence at 6 months reported by all patients.…”

Section: Discussionmentioning

confidence: 99%

Introduction of salvage prostatectomy in Denmark: the initial experience

Mortensen

Poulsen

Ahlgren³

et al. 2022

BMC Res Notes

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Objective To introduce salvage prostatectomy in Denmark. Prior to this, no national curative treatment for recurrent prostate cancer following radiation therapy existed in Denmark. This pilot study represent our initial experiences and the feasibility of performing salvage robot-assisted radical prostatectomy for true local, high-risk recurrence after initial therapy with external beam radiation for high-risk prostate cancer. Results Five patients underwent sRARP between April 2020 and July 2021. All patients were discharged within 48 h and no major complications were observed within 3 months. All patients had unmeasurable PSA (< 0.1 ng/ml) at follow-up 6 months after surgery. One patient with longer follow-up than 6 months experienced biochemical recurrence. At 3-months follow-up all patients reported considerable incontinence, at 6-month follow-up, pad usage decreased to 1 or 2 pads daily. Based on our initial results, the idea to introduce sRARP as a nationwide option remains and further patients will be included to establish the true role of sRARP in patients with recurrence after primary radiotherapy for PCa.

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“…Отмечена разница в объеме кровопотери в пользу РАРП почти в 2 раза. Это связано как с более адекватной диссекцией в ходе операции, так и с положительным давлением в брюшной полости за счет карбоксиперитонеума [17].…”

Section: Discussionunclassified

The importance of surgical access in the treatment of patients with prostate cancer and abnormal prostate anatomy

et al. 2022

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Background. The increased volume of the prostate in patients with confirmed prostate cancer (pc) is observed in 10 % of cases. The limitations of external beam radiotherapy and brachytherapy associated with large prostate volume and obstructive symptoms define radical prostatectomy (Rp) as the only possible treatment for prostate cancer in these patients. The purpose of the study was to determine the importance of the surgical approach in radical prostatectomy in patients with abnormal anatomy of the prostate. Material and methods. The study group consisted of patients with a prostate volume of more than 80 cm3 (n=40) who underwent a robot prostatectomy. The comparison group was represented by patients also selected by the prostate volume ≥ 80 cm3, who underwent classical open prostatectomy (n=44). The groups were comparable in age and psa level. The average prostate volume in the study group was 112.2 ± 26 cm 3(80–195 cm 3). The average prostate volume in the comparison group was 109.8 ± 18.7 cm3 (80–158 cm 3) (р>0.05). Both groups had favorable morphological characteristics. Results. The average surgery time difference was 65 minutes in favor of the open prostatectomy (p<0.05). The average blood loss volume in the study group was 282.5 ± 227.5 ml (50–1000 ml). The average blood loss volume in the group with open prostatectomy was 505.7 ± 382.3 ml (50–2000 ml). Positive surgical margin in the robotic prostatectomy was not detected, at 6.9 % in the group with open prostatectomy (p<0.05). According to the criterion of urinary continence, the best results were obtained in the group of robotic prostatectomy (p<0.05). Overall and relapse-free 5-year survival did not show a statistically significant difference. Conclusion. The use of robotic prostatectomy in a group of patients with a large prostate volume (≥ 80 cm3) allows us to achieve better functional and oncological outcomes.

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Techniques and Outcomes of Salvage Robot-Assisted Radical Prostatectomy (sRARP)

Cited by 27 publications

References 16 publications

Immediate post-operative PDE5i therapy improves early erectile function outcomes after robot assisted radical prostatectomy (RARP)

Immediate post-operative PDE5i therapy improves early erectile function outcomes after robot assisted radical prostatectomy (RARP)

Introduction of salvage prostatectomy in Denmark: the initial experience

The importance of surgical access in the treatment of patients with prostate cancer and abnormal prostate anatomy

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