Comparative Outcomes of Salvage Retzius-Sparing versus Standard Robotic Prostatectomy: An International, Multi-Surgeon Series
| Autor: | Antonio Galfano, Yannic Raskin, Jonathan Hwang, Scott Johnson, Christopher G. Eden, Karen Fransis, Prasanna Sooriakumaran, Kenneth Jacobsohn, Aldo Massimo Bocciardi, Isaac Yi Kim, Keith J. Kowalczyk, Rabii Madi, Jim C. Hu, Steven Joniau |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Robotic assisted Urology medicine.medical_treatment Risk Assessment Prostate cancer Postoperative Complications Robotic Surgical Procedures Incontinence Pads parasitic diseases Humans Medicine Robotic prostatectomy Salvage prostatectomy Aged Retrospective Studies Prostatectomy Salvage Therapy integumentary system business.industry Prostate Prostatic Neoplasms Middle Aged medicine.disease Surgery Treatment Outcome Urinary Incontinence Feasibility Studies Human medicine business Organ Sparing Treatments |
| Zdroj: | The journal of urology |
| ISSN: | 1527-3792 0022-5347 |
| DOI: | 10.1097/ju.0000000000001939 |
| Popis: | Purpose: Salvage radical prostatectomy is rare due to the risk of postoperative complications. We compare salvage Retzius-sparing robotic assisted radical prostatectomy (SRS-RARP) with salvage standard robotic assisted radical prostatectomy (SS-RARP). Materials and Methods: A total of 72 patients across 9 centers were identified (40 SRS-RARP vs 32 SS-RARP). Demographics, perioperative data, and pathological and functional outcomes were compared using Student's t-test and ANOVA. Cox proportional hazard models and Kaplan-Meier curves were constructed to assess risk of incontinence and time to continence. Linear regression models were constructed to investigate postoperative pad use and console time. Results: Median followup was 23 vs 36 months for SRS-RARP vs SS-RARP. Console time and estimated blood loss favored SRS-RARP. There were no differences in complication rates or oncologic outcomes. SRS-RARP had improved continence (78.4% vs 43.8%, p 0-1 pad (HR 0.28, 95% CI 0.10-0.79, p=0.016), although not when defined as >0 pad (HR 0.56, 95% CI 0.31-1.01, p=0.053). On adjusted analysis SRS-RARP was associated with decreased pads per day. Lymph node dissection and primary treatment with stereotactic body radiation therapy were associated with longer console time. Conclusions: SRS-RARP is a feasible salvage option with significantly improved urinary function outcomes. This may warrant increased utilization of SRS-RARP to manage men who fail nonsurgical primary treatment for prostate cancer. |
| Databáze: | OpenAIRE |
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