Open Access

ARTICLE

Robotic-assisted laparoscopic versus open salvage radical prostatectomy following radiotherapy

Patrick A. Kenney¹, Cayce B. Nawaf¹, Mahmoud Mustafa², Sijin Wen³, Matthew F. Wszolek⁴, Curtis A. Pettaway⁵, John F. Ward⁵, John W. Davis⁵, Louis L. Pisters⁵

1 Department of Urology, Yale School of Medicine, New Haven, Connecticut, USA
2 Department of Urology, Najaj University School of Medicine, Nablus, Palestine
3 Department of Biostatistics, West Virginia University Health Science Center, Morgantown, West Virginia, USA
4 Department of Urology, Massachusetts General Hospital, Boston, Massachusetts, USA
5 Department of Urology, MD Anderson Cancer Center, Houston, Texas, USA
Address correspondence to Dr. Louis L. Pisters, Department of Urology, MD Anderson Cancer Center, 1515 Holcombe, Unit 1373, Houston, TX 77030 USA

Canadian Journal of Urology 2016, 23(3), 8271-8277.

Abstract

Introduction: To describe immediate perioperative outcomes of robot-assisted laparoscopic salvage radical prostatectomy for recurrent cancer following radiation therapy, and compare outcomes to a contemporary open surgical cohort.
Materials and methods: A total of 39 patients underwent salvage radical prostatectomy with pelvic lymphadenectomy (20 robotic, 19 open) for local recurrence following radiation therapy at a single institution between 2007 and 2011. Intraoperative parameters, postoperative complications, and oncological outcomes were recorded. Wilcoxon rank-sum test and Fisher's exact test were used for comparison of continuous and categorical variables respectively. Mean values of numeric variables are reported with standard deviation.
Results: The cohorts were similar with respect to age, ethnicity, and American Society of Anesthesiologists Score classification. Estimated blood loss was lower in the robotic group versus the open group (381.3 mL versus 865.0 mL, p = 0.001). There was no difference in the rate of intraoperative complications, postoperative Clavien ≥ 3 complications (30% versus 15.7%), anastomotic leak (40% versus 42.1%), or wound infection (0% versus 15.7%) in the robotic and open groups. Mean node yield (10.4 versus 11.8), positive surgical margins (15.0% versus 15.7%), and undetectable prostate-specific antigen rate (78% versus 60%) were also similar between the robotic and open groups.
Conclusions: Robotic salvage prostatectomy appears to have no significant difference to the open approach with respect to safety and surgical quality as measured by complications, node yield and surgical margins in this retrospective single-institution series.

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