Introduction

Among the different approaches to treat recurrent prostate cancer only 2% of the patients undergo salvage RP because, despite good cancer control, historically, salvage RP has been associated with significant morbidity and poor functional outcomes_x000D_ _x000D_ To analyze the learning curve in terms of morbidity, oncological and functional outcomes in Salvage Robotic Assisted Radical Prostatectomy (sRARP) patients in a single surgeon tertiary-referral center._x000D_

Methods

In our IRB approved retrospective analysis >9000 patients underwent RARP for localized prostate cancer (PCa) by a single surgeon (V.P) between January 2008 and March 2016. Among those patients, 80 underwent sRARP due to a local recurrence after primary treatment. Within the current learning curve analysis, all of the 80 sRARP patients were then sub-divided in 4 equal groups of 20 consecutive patients based on date of surgery. Functional and oncological outcomes were measured at 12 months post-sRARP in Groups 1-3 only, as group 4 had limited follow-up. Potency was defined as the ability to achieve a successful erection with penetration over 50% of the time, while full and 0-2 continence was defined as 0 pads and ?2 pads/day, respectively.

Results

Preoperatively; a trend to decrease was observed through the 4 groups in terms of operative time (137 to 125 min; p=0.022), estimated blood loss (137 to 117ml; p=0.346) and catheterization time (16.95 to 12.2; p=0.182). Radiographic anastomotic leaks trended towards a decline (from 50% to 20%; p=0.126), while morbidity remained stable thorough the groups (5%; p>0.05). Biochemical failure was similar between 3 groups (30%, 31.3%, and 21.4% respectively: p=0.797) and all patients were alive at 12 months of follow up. Potency rates tended to increase from 10% in GI to 28.6% in GIII (p=0.378). Full and 0-2pads continence rates were similar among the groups (50-57.9%; p=0.859 and 60-68.4%: p=0.860 respectively). Lastly; a clinical reduction in time to continence was observed from GI to GIII (112.3 to 71.28 days; p=0.393).

Conclusions

The learning curve over the course of ~8 years demonstrated a decrease in operative time and suggested a trend for decreases in intraoperative blood loss, catheterization time and anastomotic leaks, while nerve sparing increased significantly through the groups. Therefore, a slightly higher potency rate and lower time to continence through the learning curve was shown. However, longer term studies are needed to confirm these results.

Funding

None