Safety and feasibility of salvage robot-assisted radical prostatectomy for recurrent prostate cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15171-e15171
Author(s):  
Andre Luis de Castro Abreu ◽  
Sanket Chauhan ◽  
Adrian Stuart Fairey ◽  
Ignacio Camacho ◽  
Alvin Goh ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Erectile Function ◽  
Cancer Control ◽  
Biochemical Failure ◽  
Perioperative Outcomes ◽  
Urinary Continence ◽  
Recurrent Prostate Cancer ◽  
Robot Assisted ◽  
Short Term

e15171 Background: The safety and feasibility of salvage robot-assisted radical prostatectomy (sRARP) for recurrent prostate cancer is unclear. Herein we report short-term cancer control, functional, and perioperative outcomes in a multi-institutional cohort. Methods: Between July 2007 and October 2011, 38 consecutive men underwent sRARP for recurrent prostate cancer at the University of Southern California (n=14) or Global Robotics Institute (n=24). Failed primary therapy was varied (external beam radiotherapy [EBRT; n=14]; interstitial brachytherapy [IBT; n=11]; EBRT + IBT [n=5]; high-intensity focused ultrasound [n=3]; cryoablation [n=3]; other [n=2]). The main outcomes were immediate biochemical failure (IBF), positive surgical margins (PSM), urinary continence and erectile function at 3 months, and complications within 90 days of surgery. Immediate biochemical failure was defined as a PSA > 0.2 ng/ml. Urinary continence was defined as the use of no pads and erectile function was defined as a SHIM score > 21. Complications were classified and graded using the Clavien system. Results: The median age was 68 years (50-83 years) and median preoperative PSA was 4.1 ng/ml (0.4-15.2 ng/ml). Preoperative biopsy Gleason score was ≤6 (n=7), 7 (n=18), and ≥8 (n=12). All procedures were completed without the need for open conversion. No patient experienced an intra-operative complication. Median estimated blood loss was 100 ml (30-300 ml) and operative time was 1.5 h (1-6h). Median length of hospital stay was 1 day (1-7 days). The median duration of urethral catheterization was 12 days (4-48 days). IBF occurred in 9 (29%) patients and PSM occurred in 7 (18%) patients. Urinary continence and erectile function occurred in 9 (34%) and 0 patients, respectively. One or more postoperative complications occurred in 12 (31%) patients. Low grade (I-II) and high grade (III-IV) complications occurred in 8 (21%) and 4 (10%) patients, respectively. No patient died. Conclusions: Salvage robot-assisted radical prostatectomy is safe and feasible. Short-term cancer control and perioperative morbidity were acceptable; however, functional recovery was poor. To date, this is the largest series worldwide.

scholarly journals Clinical significance and risk factors of urethrovesical anastomotic urinary leakage following robot-assisted radical prostatectomy: a multi-institutional study

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shigenori Kakutani ◽  
Yuta Takeshima ◽  
Yuta Yamada ◽  
Tetsuya Fujimura ◽  
Shoichi Nagamoto ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Risk Factors ◽  
Radical Prostatectomy ◽  
Clinical Significance ◽  
Final Analysis ◽  
Urinary Continence ◽  
Robot Assisted ◽  
Urinary Leakage ◽  
Postoperative Continence ◽  
The University

Abstract Background There has been a limited number of reports on the significance and risk factors of urethrovesical anastomotic urinary leakage (AUL) following robot-assisted radical prostatectomy (RARP). We aimed to analyze the clinical significance of AUL and evaluated its risk factors. Methods We conducted a multi-institutional study to review patients with prostate cancer undergoing RARP in three centers (The University of Tokyo Hospital, Mitsui Memorial Hospital, and Chiba Tokushukai Hospital). “Positive AUL” was defined as urinary extravasation at the anastomosis detected by post-operative cystogram and was further categorized into minor or major AUL. Univariate and multivariate analyses were performed to identify predictors of AUL. Postoperative continence rates and time to achieve continence were also analyzed. Results A total of 942 patients underwent RARP for prostate cancer in 3 centers. Of these patients, a cystogram after the RARP procedure was not performed in 26 patients leaving 916 patients for the final analysis. AUL was observed in 56 patients (6.1%); 34 patients (3.7%) with minor AUL and 22 patients (2.4%) with major AUL. Patients with major AUL exhibited a significantly longer time to achieve continence than those without major AUL. Multivariate analysis demonstrated that longer console time (≥ 184 min) was significantly associated with overall AUL, and higher body mass index (≥ 25 g/kg2) was a significant predictor of both major and overall AUL. Conclusions The presence of major AUL was associated with the achievement of urinary continence, suggesting clinical relevance of its diagnosis by postoperative cystogram. A selective cystogram has been proposed for high-risk cases. Furthermore, identification of the risk factors of AUL will lead to optimal application.

MP83-12 SALVAGE ROBOT-ASSISTED RADICAL PROSTATECTOMY FOR RECURRENT PROSTATE CANCER.

2015 ◽  
Vol 193 (4S) ◽  
Author(s):  
Andre Luis de Castro Abreu ◽  
Monish Aron ◽  
Noah Swann ◽  
Srinivas Samavedi ◽  
Anthony Bates ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Recurrent Prostate Cancer ◽  
Robot Assisted

scholarly journals 1218 SALVAGE ROBOT-ASSISTED RADICAL PROSTATECTOMY FOR RECURRENT PROSTATE CANCER: SAFETY AND FEASIBILITY

2013 ◽  
Vol 189 (4S) ◽  
Author(s):  
Andre Luis de Castro Abreu ◽  
Sanket Chauhan ◽  
Adrian Fairey ◽  
Ignacio Camacho ◽  
Alvin Goh ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Recurrent Prostate Cancer ◽  
Robot Assisted

scholarly journals Does urethral length affect continence outcomes following robot assisted laparoscopic radical prostatectomy (RALP)?

2019 ◽  
Author(s):  
Diwei Lin ◽  
Michael E O'Callaghan ◽  
Rowan David ◽  
Andrew Fuller ◽  
Richard Wells ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Short Form ◽  
High Volume ◽  
Urinary Continence ◽  
Resonance Imaging ◽  
Robot Assisted ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri ◽  
Radiotherapy Treatment

Abstract Purpose Post-operative urinary incontinence is a significant concern for patients choosing to undergo a radical prostatectomy (RP) for treatment of prostate cancer. The aim of our study was to determine the effect of pre-operative MUL on 12 month continence outcomes in men having robot-assisted laparoscopic prostatectomy (RALP).Methods We use the South Australian Prostate Cancer Clinical Outcomes Collaborative (SA-PCCOC) database, to identify 602 patients who had undergone RALP by a high volume surgeon. Only patients who received an assessment and education by a specialist pelvic floor physiotherapist, had completed EPIC questionnaires before treatment and did not have radiotherapy treatment within 12 months of surgery were included. MUL measurements were taken from pre-operative magnetic resonance imaging (MRI) scans. The short-form version of the Expanded Prostate Cancer Index Composite (EPIC-26) was used to measure continence outcomes. Continence was defined as 100/100 in the EPIC-26 Urinary Continence domain score.Results The observed median MUL in this study was 14.6mm. There was no association between MUL and baseline continence. MUL was associated with continence at 12 months post RALP (OR 1.13, 95% CI 1.03-1.21, p=0.0098). In men who were continent before surgery, MUL was associated with return to continence at 12 months after RALP (OR 1.15, 1.05-1.28, p=0.006). MUL was also associated with change in continence after surgery (β=1.22, p=0.002).Conclusions MUL had no effect on baseline continence but had a positive and significant association with continence outcomes over 12 months post RALP.

SAVING LYMPHADENECTOMY IN PATIENTS WITH RECURRENT PROSTATE CANCER AFTER RADICAL PROSTATECTOMY

2017 ◽  
Vol 63 (1) ◽  
pp. 62-68
Author(s):  
Aleksandr Vasilev ◽  
Aleksandr Govorov ◽  
Dmitriy Pushkar
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Lymph Nodes ◽  
Imaging Techniques ◽  
Emission Tomography ◽  
Recurrent Prostate Cancer ◽  
Resonance Imaging ◽  
Robot Assisted ◽  
Multiparametric Magnetic Resonance Imaging ◽  
Positron Emission

A separate group of patients who underwent radical prostatectomy are patients with isolated recurrence of cancer in lymph nodes limited by regional and/or retroperitoneal lymph nodes. As one method of treatment of this patient group it could be applied lymphadenectomy by open or laparoscopic (robot-assisted) approach. The analysis of literature references indicates an increase of overall survival in this group of patients after lymphadenectomy. Imaging techniques such as multiparametric magnetic resonance imaging and positron emission tomography allow more accurately identifying lymph nodes damage in patients with biochemical recurrence of prostate cancer after radical prostatectomy.

scholarly journals Functional and oncological outcomes of salvage external beam radiotherapy following robot-assisted radical prostatectomy in a Canadian cohort

2017 ◽  
Vol 12 (2) ◽  
pp. 45-9
Author(s):  
Khaled Ajib ◽  
Marc Zanaty ◽  
Mansour Alnazari ◽  
Emad Rajih ◽  
Pierre-Alain Hueber ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
External Beam Radiotherapy ◽  
Specific Antigen ◽  
Urinary Continence ◽  
Robot Assisted ◽  
Time Points ◽  
Canadian Experience ◽  
Significant Difference ◽  
The Impact

Introduction: We sought to determine the impact of salvage radiotherapy (SRT) on oncological and functional outcomes of patients with prostate cancer after biochemical recurrence (BCR) following robot-assisted radical prostatectomy (RARP).Methods: Data of 70 patients with prostate cancer treated with SRT after developing BCR were retrospectively analyzed from a prospectively collected RARP database of 740 men. Oncological (prostate- specific antigen [PSA]) and functional (pads/day, International Prostate Symptom Score [IPSS], and Sexual Health Inventory for Men [SHIM]) outcomes were reported at six, 12, and 24 months after RT and adjusted for pre-SRT status.Results: Men who underwent SRT had a mean age, PSA, and time from radical prostatectomy (RP) to RT of 61.8 years (60.1‒63.6), 0.5 ng/ml (0.2‒0.8), and 458 days (307‒747), respectively. Freedom from biochemical failure (FFBF) post-SRT, defined as a PSA nadir <0.2 ng/mL, was observed in 89%, 93%, and 81%, at six, 12, and 24 months, respectively. Undetectable PSA was observed in 14%, 35%, and 40% at the same time points, respectively. There was no significant difference in urinary continence post-SRT (p=0.56). Rate of strict continence (0 pads/day) was 71% at 24 months compared to 78% pre-SRT. Mean IPSS at six, 12, and 24 months was 3.4, 3.6, and 3.6, respectively compared to pre-RT score of 3.3 (p=0.61). The mean SHIM score pre-SRT was comparable at all time points following treatment (p=0.86).Conclusions: In this unique Canadian experience, it appears that early SRT is highly effective for the treatment of BCR following RARP with little impact on urinary continence and potency outcomes.

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