Data di Pubblicazione:
2011
Citazione:
Salvage robot-assisted radical prostatectomy : single surgeon experience / B. Rocco, G. Albo, P. Acquati, K.J. Palmer, S. Chauhan, A. Sivaraman, R.F. Cohelo, V. Patel. ((Intervento presentato al 21. convegno Annual meeting of the Italian society of uro-oncology tenutosi a Napoli nel 2011.
Abstract:
Aim: The objective of this study is to report the perioperative,
functional and oncologic outcomes of salvage robot-assisted
radical prostatectomy (sRARP). Patients and Methods: We
identified 19 patients who underwent sRARP with bilateral
limited pelvic lymph node dissection by a single surgeon
between July 2002 and October 2010. RT consisted of XRT
in nine cases, brachytherapy in seven cases, brachytherapy
plus XRT in two cases and proton beam therapy in one case.
Biochemical failure was defined as a PSA of >2.0 ng/ml over
the absolute nadir. Continence was defined as the use of ‘no
pads’ after surgery and potency was defined as the ability to
achieve and maintain adequate erection for penetration, with
or without PDE-5 inhibitors. Biochemical recurrence (BCR)
was defined as a PSA of >0.2 ng/ml after sRARP. Results: The
median (IQR) age, BMI, SHIM score and AUA score were 66
(range: 60-70.5) years, 30 (range: 37-32.5) kg/m2, 5 (range: 4-
15), and 12 (range: 7.5-13), respectively. The median PSA
nadir after RT and the median PSA before surgery were 4.3
(range: 3.4-4.9) and 1.2 (range: 0.75-1.2) ng/ml, respectively.
Six patients were placed on ADT. The median OR time and
blood loss were 92.5 (range: 90-107.5) min and 100 (range:
100-100) ml, respectively. A partial nerve-sparing surgery was
performed in five (26.3%) patients, while all other patients
underwent non nerve-sparing surgery. On histopathological
evaluation, five patients (26.3%) had pT2 disease, eight
(42.1%) had pT3a, while five (26.3%) had pT3b. Due to
intense scarring, it was not feasible to accurately stage one
prostate. Three patients (15.8%) had a positive surgical
margin. The median Gleason score, prostate weight and tumor
volume were 8 (range: 7-8), 34 (range: 25-43) g and 25%
(range: 16-32%), respectively. The median length of hospital
stay and days on catheter were 1 (range: 1-2) day and 8
(range: 7-11) days, respectively. Two (10.5%) patients had
three complications (15.8%). Two patients had anastomosis
leak (1d), both treated by extended Foley’s catheterization.
One of these developed an anastomotic stricture (Clavien 3a)
at six months and was treated by direct internal urethrotomy.
There were no rectal injuries or bladder neck contractures.
Fifteen patients had at least six months of follow-up, of whom
twelve (80%) were continent. The median time to achieve
continence was 5.5 (range: 2.6-9) months. Only two patients
who had partial nerve-sparing surgery had six months of
follow-up, and none of them were potent. On a median followup
of 24 (range: 6-45) months, 4 patients (21%) had BCR.
Conclusion: sRALP is a technically challenging but feasible
procedure. The challenge lies in extensive fibrosis and loss of
dissection planes, secondary to radiation therapy. This is the largest published single surgeon series and it shows
encouraging perioperative, continence and oncologic
outcomes.
Tipologia IRIS:
14 - Intervento a convegno non pubblicato
Elenco autori:
B. Rocco, G. Albo, P. Acquati, K.J. Palmer, S. Chauhan, A. Sivaraman, R.F. Cohelo, V. Patel
Link alla scheda completa: