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341 Surgical, oncologic and functional outcomes in patients undergoing salvage robotic-assisted laparoscopic radical prostatectomy for the treatment of recurrent prostate cancer
341 - Surgical, oncologic and functional outcomes in patients undergoing salvage robotic-... Page 1 of 1
e341 Surgical, oncologic and functional outcomes in patients undergoing salvage roboticassisted laparoscopic radical prostatectomy for the treatment of recurrent prostate cancer Labanaris A.P., Zugor V., Wagner C., Schuette A., Lange P., Witt J.H. Prostate Center Northwest, St. Antonius Medical Center, Gronau, Germany, Dept. of Urology and Pediatric Urology, Gronau, Germany INTRODUCTION & OBJECTIVES: The objective of this study is to assess the surgical, oncologic and functional outcomes in patients undergoing salvage robot-assisted laparoscopic radical prostatectomy (RALP) for the treatment of recurrent prostate cancer (PCa). MATERIAL & METHODS: The records of N=16 men who underwent salvage RALP from February 2006 to July 2011 were retrospectively reviewed. The parameters analyzed included: age, prostate size, PSA values, biopsy Gleason score, clinical stage, pathologic stage, lymph node status, positive surgical margins (PSM), percentage of PCa found in the specimen, blood loss, skin-to-skin operative time, intraoperative complications, minor (Clavien’s grade I–IIIa) and major complications (Clavien’s grade IIIb-IVa), continence potency, disease-specific mortality as well as biochemical progression in the follow up period, defined as PSA ≥0.2 mg/dl after nadir or never reached nadir. RESULTS: Primary treatment was brachytherapy in N=6 patients (37.5%), 43 months (range 13-63 months) prior to RALP. External beam radiation in N=6 cases (37.5%), 58 months (range 46-92 months) prior and HIFU in N=4 patients (25%), 27 months (range 11-48 months) prior to RALP. Preoperative N= 11 patients were impotent (68.7%). Prior to RALP all patients underwent a re-biopsy, computer tomography and bone scan which exluded metastatic disease. The median age of the patients was 64.6 years, median prostate weight 37.2 gr. and median PSA 12.1 ng/ml. The clinical stage was thought to be confined in all cases. The Gleason biopsy score was 7 in N=6 patients (37.5%). Intraoperative and major complications were not encountered. N=3 patients (18.75%) exhibited a minor complication. The pathologic stage exhibited a confined tumor in N=6 patients (37.5%) and an extracapsular extension in N=10 cases (62.5%). The Gleason score of the prostate specimen was upgraded in N=6 cases (37.5%). The percentage of PCa found in the prostate specimen was 18.2%, PSM were not encountered and lymph nodes were positive in N=1 patient (6.25%). After a median follow up of 26.1 months (range 4-53) N=13 patients (81.25) were continent and N=3 (18.7%) were potent. No disease-specific mortality was evident but biochemical progression was noticed in N=7 patients (43.7%). Salvage RALP is a safe and effective therapeutic modality in patients with locally recurrent PCa. Although the surgical and oncologic outcomes are satisfying, patients should be made aware of suboptimal functional outcomes before undergoing the procedure. CONCLUSIONS: Salvage RALP is a safe and effective therapeutic modality in patients with locally recurrent PCa. Although the surgical and oncologic outcomes are satisfying, patients should be made aware of suboptimal functional outcomes before undergoing the procedure.
file://F:\RamShankar\April\04-05-12\Cip\Sour\341.html
4/6/2012
e341 Surgical, oncologic and functional outcomes in patients undergoing salvage roboticassisted laparoscopic radical prostatectomy for the treatment of recurrent prostate cancer Labanaris A.P., Zugor V., Wagner C., Schuette A., Lange P., Witt J.H. Prostate Center Northwest, St. Antonius Medical Center, Gronau, Germany, Dept. of Urology and Pediatric Urology, Gronau, Germany INTRODUCTION & OBJECTIVES: The objective of this study is to assess the surgical, oncologic and functional outcomes in patients undergoing salvage robot-assisted laparoscopic radical prostatectomy (RALP) for the treatment of recurrent prostate cancer (PCa). MATERIAL & METHODS: The records of N=16 men who underwent salvage RALP from February 2006 to July 2011 were retrospectively reviewed. The parameters analyzed included: age, prostate size, PSA values, biopsy Gleason score, clinical stage, pathologic stage, lymph node status, positive surgical margins (PSM), percentage of PCa found in the specimen, blood loss, skin-to-skin operative time, intraoperative complications, minor (Clavien’s grade I–IIIa) and major complications (Clavien’s grade IIIb-IVa), continence potency, disease-specific mortality as well as biochemical progression in the follow up period, defined as PSA ≥0.2 mg/dl after nadir or never reached nadir. RESULTS: Primary treatment was brachytherapy in N=6 patients (37.5%), 43 months (range 13-63 months) prior to RALP. External beam radiation in N=6 cases (37.5%), 58 months (range 46-92 months) prior and HIFU in N=4 patients (25%), 27 months (range 11-48 months) prior to RALP. Preoperative N= 11 patients were impotent (68.7%). Prior to RALP all patients underwent a re-biopsy, computer tomography and bone scan which exluded metastatic disease. The median age of the patients was 64.6 years, median prostate weight 37.2 gr. and median PSA 12.1 ng/ml. The clinical stage was thought to be confined in all cases. The Gleason biopsy score was 7 in N=6 patients (37.5%). Intraoperative and major complications were not encountered. N=3 patients (18.75%) exhibited a minor complication. The pathologic stage exhibited a confined tumor in N=6 patients (37.5%) and an extracapsular extension in N=10 cases (62.5%). The Gleason score of the prostate specimen was upgraded in N=6 cases (37.5%). The percentage of PCa found in the prostate specimen was 18.2%, PSM were not encountered and lymph nodes were positive in N=1 patient (6.25%). After a median follow up of 26.1 months (range 4-53) N=13 patients (81.25) were continent and N=3 (18.7%) were potent. No disease-specific mortality was evident but biochemical progression was noticed in N=7 patients (43.7%). Salvage RALP is a safe and effective therapeutic modality in patients with locally recurrent PCa. Although the surgical and oncologic outcomes are satisfying, patients should be made aware of suboptimal functional outcomes before undergoing the procedure. CONCLUSIONS: Salvage RALP is a safe and effective therapeutic modality in patients with locally recurrent PCa. Although the surgical and oncologic outcomes are satisfying, patients should be made aware of suboptimal functional outcomes before undergoing the procedure.
file://F:\RamShankar\April\04-05-12\Cip\Sour\341.html
4/6/2012