PD42-04 OUTCOMES OF SALVAGE ROBOT-ASSISTED RADICAL PROSTATECTOMY POST PRIMARY RADIATION AND THERMAL ABLATION THERAPIES.

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy VI1 Apr 2018PD42-04 OUTCOMES OF SALVAGE ROBOT-ASSISTED RADICAL PROSTATECTOMY POST PRIMARY RADIATION AND THERMAL ABLATION THERAPIES. Mario Mekhail, Luis Medina, Giovanni Cacciamani, Akbar Ashrafi, Matthew Winter, Peter Mekhail, Sameer Chopra, Andre Berger, Rene Sotelo, Hooman Djaladat, Mihir Desai, Inderbir Gill, Andre Abreu, and Monish Aron Mario MekhailMario Mekhail More articles by this author , Luis MedinaLuis Medina More articles by this author , Giovanni CacciamaniGiovanni Cacciamani More articles by this author , Akbar AshrafiAkbar Ashrafi More articles by this author , Matthew WinterMatthew Winter More articles by this author , Peter MekhailPeter Mekhail More articles by this author , Sameer ChopraSameer Chopra More articles by this author , Andre BergerAndre Berger More articles by this author , Rene SoteloRene Sotelo More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , Mihir DesaiMihir Desai More articles by this author , Inderbir GillInderbir Gill More articles by this author , Andre AbreuAndre Abreu More articles by this author , and Monish AronMonish Aron More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1957AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To report perioperative, functional and oncological outcomes of salvage robot-assisted radical prostatectomy (sRARP) post radiation and thermal ablation treatments. METHODS We retrospectively reviewed the records of 62 patients who underwent sRARP from our IRB-approved prostatectomy database. sRARP was performed transperitoneally using the da Vinci system. The endpoints were positive surgical margins (PSM), 30-day post-operative complications (POC; by Clavien system), urinary continence (UC; use of no pads), erectile function (EF; SHIM score > 21), and biochemical failure (BF; PSA > 0.2 ng/ml). The patients were divided into two groups: post-radiation (RT) and post-thermal ablation therapy (AT). Continuous and categorical variables are presented as mean, standard deviation (SD) and frequencies (%), respectively. Statistical analyses were performed using SPSS v.24.0 (significant if p<0.05) RESULTS A total of 48 patients (77%) underwent sRARP post RT and 14 patients (23%) post AT. RT were as follows: external beam radiotherapy (EBRT) in 30 patients (48%); brachytherapy in 10 (16%); combined (EBRT and brachytherapy) in 8 (8%). AT were as follows: HIFU in 3 (5%); cryoablation in 10 (16%); proton therapy in 3 (5%); others in 1 (2%). Pre-sRARP, the mean age (67.85 v 68.43; p=0.8), PSA (9.61 v 11.6 ng/mL; p=0.54) and Gleason score = 3+4 (85% v 64%; p=0.078), were not significantly different for RT and AT, respectively. There were no conversions to open surgery. Operative time (254.6 v 273.2 min, p=0.33), estimated blood loss (125.7 v 121.3 mL, p=0.81), length of hospital stay (3 v 2 day, p=0.44) and catheter duration (15 v 11 days, p=0.07) were not significant different between RT and AT. Clavien = 3 POC (33.3% v 7.1%, p=0.09), urinary tract infection (12.5% v 7.1%), urine retention and anastomotic leak (10.4% v 0%), and bladder neck contracture (2.1% v 0%) trended higher after RT, but were not statistically different. There was one rectal injury in the RT group. On final pathology, PSM rate (31% v 36%, p=1), seminal vesicle invasion (40% v 43%, p=1), Gleason Score = 3+4 (94% v 14 100%, p=0.364), stage pT3b (29% v 43%, p=0.75), and pN1 of (25% v 36%, p=0.5) were not statistically different in RT and AT groups, respectively. At a median of 13 months of follow up, continence (35% v 50%, p=0.3) and potency recovery (12% v 23%, p=0.35), and BF (22% v 18%, p=0.7) were not significantly different for RT and AT, respectively. CONCLUSIONS sRARP post radiation and thermal ablation showed no statistically significant differe