Robotic better than open salvage radical prostatectomy for recurrent prostate cancer

Salvage radical prostatectomy results in better functional outcomes and has a low risk of major complications as compared to those previously reported, a study claims. Furthermore, robotic salvage radical prostatectomy appears to reduce anastomotic stricture, blood loss and hospital stay, and improve continence outcomes.

Of the 395 salvage radical prostatectomies included, 186 were open and 209 were robotic. The latter approach resulted in lower blood loss and a shorter hospital stay (p-each<0.0001). There was no significant difference in the incidence of major (10.1 percent; p=0.16) and overall complications (34.9 percent; p=0.67), including an overall low risk of rectal injury (1.58 percent) and fistula (2.02 percent).

The open approach, on the other hand, led to more frequent anastomotic stricture (16.57 percent vs 7.66 percent; p<0.01).

Severe incontinence, defined as use of ≥3 pads per day, occurred in 24.6 percent of patients for 12 or 6 months. Multivariable analysis revealed that robotic salvage radical prostatectomy independently predicted continence preservation (odds ratio, 0.411, 95 percent CI, 0.232–0.727; p=0.022).

In this study, the authors retrospectively collected data on salvage radical prostatectomy for recurrent prostate cancer after local nonsurgical treatment at 18 tertiary referral centres from 2000 to 2016. Complications were classified by applying the Clavien-Dindo classification. Univariable and multivariable analyses were performed to assess complications and functional outcomes.

The study was limited by its retrospective nature and the absence of a standardized surgical technique.

“Salvage radical prostatectomy has historically yielded a poor functional outcome and a high complication rate,” the authors said. “However, recent reports of robotic salvage radical prostatectomy have demonstrated improved results.”