Salvage robotic-assisted laparoscopic radical prostatectomy (S-RARP)

Purpose: To report the perioperative, functional and oncological outcomes of salvage robot-assisted laparoscopic prostatectomy (S-RARP).

Materials and Methods: From Dec. 2005 to Apr. 2016, 1200 cases received RARP performed by a single surgeon. Among them, fourteen (1.16%) received S-RARP and enrolled to this study. Mean age was 67.42 (51–79) yrs. PSA level at Initial diagnosis ranged from 3.4–64 ng/ml with mean17.44 ng/ml. Initial clinical stage T1/T2/T3 was 4/8/2 patients. Initial mean tumor percentage in transrectal ultrasound guiding biopsy was 27.29%(4–80%).Initial mean Gleason score was 7.35, and Gleason score ≥8 in 35.7% (5/14). Risk classification low/intermediate/high was in 3, 2 and 9 cases, respectively. Initial treatment was external irradiation in 10 cases, brachytherapy in 2 cases, cyberknife in one and High intensity focused ultrasound (HIFU) in one. Combined with hormonal therapy was8 (57.1%) patients. Nadir PSA level after treatment ranged from 0.1–8.8 ng/ml with mean1.47 ng/ml. PSA level at S-RARP ranged 0.5–8.8 ng/ml with mean 7.96 ng/ml. Duration to S-RARP range from 13 to 60 months with mean 26.9 months after initial diagnosis.

Results: Clinical stage at S-RARP was 8 cases of T2 and 6 cases of T3. Mean console time was 133.8 min (ranged 105–165 min). Estimated Blood loss was 88.93 ml (30–160 ml). Clavien I complication of intraoperative urinary tear with repair in one patients.Final pathology pT2/T3/T4 in 7/5/2 and lymph node metastasis in one patient. Mean tumor volume was 5.5 cm³ and tumor percentage 14.36% (1–40%). Positive surgical margin was 28.6%(4/14).Contience rate with zero pad in 78.5% (11/14), the timing from 2 weeks to one year after removal of foley catheter. Mild stress urinary incontinence (one pad/ day) in 21.5% (3/14). Neurovascular bundle preservation in 3 patient and postoperatively 2 patient with potent.Mean post-operative followup period from 2 to 50months with mean 30.4 months. Biochemical recurrence (BCR)-free in 11 (78.5%) was noted. Two-year and 3-year survival rate was 50% and 42.9%.

Conclusion: Salvage Robotic-Assisted Laparoscopic Prostatectomy is a technically feasible operation with low complication. Operative time was increased but no significantly increased blood loss. Continence rate was excellent. Potency rate was acceptable. Short-term oncological outcomes are encouragingand necessary with longer follow-up to draw significant conclusions.