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Morbidity of salvage radical prostatectomy: limited impact of the minimally invasive approach

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Abstract

Purpose

We aimed to report the morbidity profile of salvage radical prostatectomy (SRP) after radiotherapy failure and assess the impact of minimally invasive surgery (MIS) on postoperative complications and functional outcomes.

Materials and methods

Between 1985 and 2019, a total of 293 patients underwent SRP; 232 underwent open SRP; and 61 underwent laparoscopic SRP with or without robotic assistance. Complications were recorded and classified into standardized categories per the Clavien-Dindo classification.

Results

Twenty-nine patients (10%) experienced grade 3 complications within 30 days, 22 (9.5%) after open and 7 (11%) after MIS (p = 0.6). Between 30 and 90 days after surgery, 7.3% of patients in the open group and 10% in the MIS group had grade 3 complications (p = 0.5). The most common complication was bladder neck contracture (BNC), representing 40% of the 30–90 day complications. Within one year of SRP, 81 patients (31%, 95% CI 25%, 37%) developed BNC; we saw non-significant lower rates in MIS (25 vs 32%; p = 0.4). Functional outcomes were poor after SRP and showed no difference between open and MIS groups for urinary continence (16 vs 18%, p = 0.7) and erectile function (7 vs 13%, p = 0.4). 5 year cancer-specific survival and overall survival was 95% and 88% for the entire cohort, respectively.

Conclusions

Our outcomes suggest poor functional recovery after SRP, regardless of the operative approach. Currently there is no evidence favoring the use of open or MIS approach. Further studies are required to ensure comparable outcomes between these approaches.

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References

  1. Dinan MA, Robinson TJ, Zagar TM et al (2012) Changes in initial treatment for prostate cancer among medicare beneficiaries, 1999–2007. Int J Radiat Oncol Biol Phys 82:e781

    Article  Google Scholar 

  2. Keto CJ, Aronson WJ, Terris MK et al (2014) Detectable prostate-specific antigen Nadir during androgen-deprivation therapy predicts adverse prostate cancer-specific outcomes: results from the SEARCH database. Eur Urol 65:620

    Article  CAS  Google Scholar 

  3. Bolla M, Van Tienhoven G, Warde P et al (2010) External irradiation with or without long-term androgen suppression for prostate cancer with high metastatic risk: 10-year results of an EORTC randomised study. Lancet Oncol 11:1066

    Article  CAS  Google Scholar 

  4. Crook JM, Perry GA, Robertson S et al (1995) Routine prostate biopsies following radiotherapy for prostate cancer: results for 226 patients. Urology 45:624

    Article  CAS  Google Scholar 

  5. Chade DC, Shariat SF, Cronin AM et al (2011) Salvage radical prostatectomy for radiation-recurrent prostate cancer: a multi-institutional collaboration. Eur Urol 60:205

    Article  Google Scholar 

  6. Gotto GT, Yunis LH, Vora K et al (2010) Impact of prior prostate radiation on complications after radical prostatectomy. J Urol 184:136

    Article  Google Scholar 

  7. Straub JM, New J, Hamilton CD et al (2015) Radiation-induced fibrosis: mechanisms and implications for therapy. J Cancer Res Clin Oncol 141:1985

    Article  CAS  Google Scholar 

  8. Philippou Y, Parker RA, Volanis D et al (2016) Comparative oncologic and toxicity outcomes of salvage radical prostatectomy versus nonsurgical therapies for radiorecurrent prostate cancer: a meta-regression analysis. Eur Urol Focus 2:158

    Article  Google Scholar 

  9. Wetherell D, Bolton D, Kavanagh L et al (2013) Current role of salvage robotic-assisted laparoscopic prostatectomy. World J Urol 31:463

    Article  CAS  Google Scholar 

  10. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205

    Article  Google Scholar 

  11. Rabbani F, Yunis LH, Pinochet R et al (2010) Comprehensive standardized report of complications of retropubic and laparoscopic radical prostatectomy. Eur Urol 57:371

    Article  Google Scholar 

  12. Martin RC 2nd, Brennan MF, Jaques DP (2002) Quality of complication reporting in the surgical literature. Ann Surg 235:803

    Article  Google Scholar 

  13. Alicikus ZA, Yamada Y, Zhang Z et al (2011) Ten-year outcomes of high-dose, intensity-modulated radiotherapy for localized prostate cancer. Cancer 117:1429

    Article  Google Scholar 

  14. Stephenson AJ, Scardino PT, Bianco FJ Jr et al (2004) Morbidity and functional outcomes of salvage radical prostatectomy for locally recurrent prostate cancer after radiation therapy. J Urol 172:2239

    Article  Google Scholar 

  15. Elliott SP, Meng MV, Elkin EP et al (2007) Incidence of urethral stricture after primary treatment for prostate cancer: data From CaPSURE. J Urol 178:529

    Article  Google Scholar 

  16. Sandhu JS, Gotto GT, Herran LA et al (2011) Age, obesity, medical comorbidities and surgical technique are predictive of symptomatic anastomotic strictures after contemporary radical prostatectomy. J Urol 185:2148

    Article  Google Scholar 

  17. Hu JC, Gu X, Lipsitz SR et al (2009) Comparative effectiveness of minimally invasive vs open radical prostatectomy. JAMA 302:1557

    Article  CAS  Google Scholar 

  18. Chade DC, Eastham J, Graefen M et al (2012) Cancer control and functional outcomes of salvage radical prostatectomy for radiation-recurrent prostate cancer: a systematic review of the literature. Eur Urol 61:961

    Article  Google Scholar 

  19. Zargar H, Lamb AD, Rocco B et al (2017) Salvage robotic prostatectomy for radio recurrent prostate cancer: technical challenges and outcome analysis. Minerva Urol Nefrol 69:26

    PubMed  Google Scholar 

  20. Marks LB, Carroll PR, Dugan TC et al (1995) The response of the urinary bladder, urethra, and ureter to radiation and chemotherapy. Int J Radiat Oncol Biol Phys 31:1257

    Article  CAS  Google Scholar 

  21. Perera M, Papa N, Christidis D et al (2016) Sensitivity, specificity, and predictors of positive (68)Ga-prostate-specific membrane antigen positron emission tomography in advanced prostate cancer: a systematic review and meta-analysis. Eur Urol 70:926

    Article  Google Scholar 

  22. Perera M, Papa N, Roberts M et al (2020) Gallium-68 Prostate-specific membrane antigen positron emission tomography in advanced prostate cancer-updated diagnostic utility, sensitivity, specificity, and distribution of prostate-specific membrane antigen-avid lesions: a systematic review and meta-analysis. Eur Urol 77:403

    Article  Google Scholar 

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Funding

This study was supported by Sidney Kimmel Center for Prostate and Urologic Cancers at MSKCC, the NIH/NCI Cancer Center Support Grant to Memorial Sloan Kettering Cancer Center (P30 CA008748), and NIH/NCI grants P50CA092629. Marlon Perera is sponsored by the Australian-America Fulbright Commission administered through a 2021–2022 Fulbright Future Scholarship funded by The Kinghorn Foundation.

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Author notes

  1. Marlon Perera and Antoni Vilaseca contributed equally.

Authors and Affiliations

  1. Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Marlon Perera, Antoni Vilaseca, Daniel P. Nguyen, Renato B. Corradi, Adam S. Touijer, Alexandre Godefroy Martin-Malburet, Ricardo Alvim, Vincent Laudone, Peter T. Scardino, James A. Eastham & Karim A. Touijer

  2. Urology Department, Hospital Clínic de Barcelona, Barcelona, Spain

    Antoni Vilaseca

  3. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Amy L. Tin, Nicole Benfante & Daniel D. Sjoberg

  4. Urology Department, Reseau Hospitalier Neuchatelois, Neuchatel, Switzerland

    Daniel P. Nguyen & Alexandre Godefroy Martin-Malburet

Authors
  1. Marlon Perera
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  2. Antoni Vilaseca
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  3. Amy L. Tin
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  4. Daniel P. Nguyen
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  5. Renato B. Corradi
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  6. Adam S. Touijer
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  7. Alexandre Godefroy Martin-Malburet
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  8. Ricardo Alvim
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  9. Nicole Benfante
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  11. Vincent Laudone
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  12. Peter T. Scardino
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  13. James A. Eastham
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  14. Karim A. Touijer
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Contributions

MP and AV contributed to manuscript writing. AT performed data analysis. DN, RC, and AM-M were involved in study design, data appraisal, manuscript editing. AT contributed to data collection and manuscript editing. RA was involved in editing. NB and DS did data collection and data analysis. VL, PS, and JE performed supervision and manuscript editing. KT contributed to supervision, study design, data appraisal, and manuscript editing.

Corresponding author

Correspondence to Karim A. Touijer.

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Perera, M., Vilaseca, A., Tin, A.L. et al. Morbidity of salvage radical prostatectomy: limited impact of the minimally invasive approach. World J Urol 40, 1637–1644 (2022). https://doi.org/10.1007/s00345-022-04031-1

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  • DOI: https://doi.org/10.1007/s00345-022-04031-1

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