Functional outcomes and complications of a multicentre series of open versus robot-assisted salvage radical prostatectomy

32nd Annual EAU Congress, 24-28 March 2017, London, United Kingdom

1078

Functional outcomes and complications of a multicentre series of open versus robot-assisted salvage radical prostatectomy Eur Urol Suppl 2017; 16(3);e1880

Gontero P.1, Marra G.1, Alessio P.1, Oderda M.1, Palazzetti A.1, Pisano F.1, Battaglia A.1, Munegato S.1, Frea B.1, Munoz F.2, Filippini C.3, Linares E.4, Sanchez-Salas R.4, Goonewardene S.5, Dasgupta P.5, Cahill D.5, Challacombe B.5, Popert R.5, Gillatt D.6, Persad R.6, Palou J.7, Joniau S.8, Smelzo S.9, Piechaud T.9, De La Taille A.10, Roupret M.11, Albisinni S.12, Van Velthoven R.12, Morlacco A.13, Vidit S.13, Gandaglia G.14, Mottrie A.14, Smith J.15, Fiscus G.15, Van Der Poel H.16, Tilki D.17, Karnes R.J.13 1

San Giovanni Battista Hospital, Dept. of Urology, Turin, Italy, 2Pasini Hospital, Dept. of Radiotherapy, Aosta, Italy, 3San Giovanni Battista Hospital, Dept. of Statistics, Turin, Italy, 4Institut Mutualiste Montsouris, Dept. of Urology, Paris, France, 5Guy's Hospital, Dept. of Urology, London, United Kingdom, 6 North Bristol NHS Foundation Trust, Dept. of Urology, Bristol, United Kingdom, 7Fundaciò Puigvert, Dept. of Urology, Barcelona, Spain, 8Leuven University Hospitals, Dept. of Urology, Leuven, Belgium, 9 Clinique Saint Augustin, Dept. of Urology, Bordeaux, France, 10CHU Mondor, Dept. of Urology, Créteil, France, 11Pitié Salpétrière Hospital- University Paris 6, Dept. of Urology, Paris, France, 12Institut Jules Bordet, Université Libre De Bruxelles,, Dept. of Urology, Brussels, Belgium, 13Mayo Clinic, Dept. of Urology, Rochester, United States of America, 14OLV Hospital, Dept. of Urology, Aalst, Belgium, 15 Vanderbilt University, Medical Center North, Dept. of Urology, Nashville, United States of America, 16 Netherlands Cancer Institute, Dept. of Urology, Amsterdam, The Netherlands, 17Martini Klinik, Dept. of Urology, Hamburg, Germany INTRODUCTION & OBJECTIVES: Historically, salvage radical prostatectomy (sRP) has been associated with high rates of peri- and post-operative complications and poor functional outcomes in terms of urinary continence (Con) and erectile function (EF). We evaluated and compared a large contemporary serie of robotic (RsRP) vs open (OsRP) sRP. MATERIAL & METHODS: We retrospectively collected data of 376 men undergoing sRP between 2000 and 2015 at 13 Tertiary referral centres. Baseline characteristics included oncological clinical and pathological features, primary treatment type, ECOG, ASA and Charlson Comorbidity Index (CCI). Complications were graded using the Clavien-Dindo score. EF and Con were assessed pre-sRP, at 6 and at 12 months with IIEF before and according to the type of therapy needed to obtain erections after sRP and with number of pads/day used respectively. Men with a follow-up <12 months or insufficient data were excluded. After testing normal distribution for continuous variables, Wilcoxon-Mann-Whitney test was used for group comparisons; Chi-square or Fisher’s exact tests were used for categorical variables. Continence trends were evaluated with analysis of variance for repeated measures. RESULTS: We included 243 men (138 OsRP and 105 RsRP) who underwent sRP after external beam radiation therapy (69.5%), cryotherapy (3.7%), HIFU (4.1%), brachytherapy (21.4%) or other primary treatments (1.2%). No significant baseline differences were present amongst groups except for the lymph-node template, more extended in the OsRP group (p<0.01) and the CCI, higher in the RsRP

Eur Urol Suppl 2017; 16(3);e1880

32nd Annual EAU Congress, 24-28 March 2017, London, United Kingdom

1078

Functional outcomes and complications of a multicentre series of open versus robot-assisted salvage radical prostatectomy Eur Urol Suppl 2017; 16(3);e1881

group (2.7±2.4 vs OsRP=0.9±1.38; p<0.01). In the RsRP group a higher number of patients underwent monolateral (1.9% vs 0.72%) or bilateral (15.2% vs 4.35%) nerve sparing (p<0.01). Mean operating time was lower for OsRP (175.3±83 vs 195.3±84 min; p<0.01). Despite mean blood loss (BL) was higher for OsRP (529.3 ±445 vs 228.4 ±170 mL; p<0.01), no differences in post-operative transfusions were present with 6.17% of men receiving ≥ 1 unit (p=0.28). Mean hospital stay (HS) was shorter for RsRP (2.98±2.7 vs 4.32±4.1 days, p<0.01). A higher number of complications overall (47.8% vs 32.3%; p=0.018) and of major type (Clavien Dindo ≥3, 30.4% vs 11.4%; p<0.01) were recorded for OsRP. Anastomotic stricture occurred more frequently in OsRP (18.8% vs 8.5%; p=0.03). Rectal injury was rare (3.62% of OsRP vs 0.9% of RsRP; p=0.23). At 1 year 7.6% of men had spontaneous erections and 55.4% (n=87) complete impotence (no group differences p=0.06); 31.1% were fully continent and 35.1% severely incontinent using ≥ 3 pads/day (no group differences p=0.35). CONCLUSIONS: sRP performed in tertiary referral centres yields acceptable functional outcomes and rates of peri- and post-operative complications. RsRP allows shorter HS, lower BL and lower complication rates compared to OsRP. However, no advantages are present in terms of Con and EF.

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