title: Pilot study of salvage laparoscopic prostatectomy for the treatment of recurrent prostate cancer.
abstract: OBJECTIVE
  • To evaluate feasibility, safety and oncological efficacy of salvage laparoscopic radical prostatectomy for pathology-proven biochemical recurrence after primary radiation therapy or cryotherapy for prostate cancer.
  
  
  METHODS
  • This retrospective pilot study examined 15 patients from 2004 to 2010 with biochemical recurrence after external beam radiation therapy (N= 8), brachytherapy (N= 6) or cryotherapy (N= 1). • Patients were treated with salvage laparoscopic radical prostatectomy (11 conventional, four robotic-assisted) with bilateral pelvic dissection.
  
  
  RESULTS
  • Median duration of surgery was 235 min. None of the following occurred: conversion to open surgery, transfusion, urethrovesical stenosis or perioperative or postoperative mortality. One patient presented with a rectal injury, repaired using uninterrupted sutures and a colostomy. One patient had anastomotic leak treated with prolonged Foley catheterization. • Pathological stage was pT2a in three, pT2b in three, pT3a in four, pT3b in three and pT4 in two patients; two patients had nodal metastasis. Within an 8-month median follow-up, 11 patients were disease-free and three had persistent postoperative prostate-specific antigen (PSA) elevation; the remaining patient experienced PSA recurrence after 21 months. • Seven patients achieved continence (no pads) by 8.4 months (median), one patient manifested severe incontinence corrected by implanting an artificial sphincter, and seven patients with a 12.6-month mean follow-up continued to need one or two pads per day. • Erectile dysfunction was present in five patients before surgery and in 14 patients after surgery.
  
  
  CONCLUSIONS
  • Salvage laparoscopic radical prostatectomy seems to offer a safe therapeutic alternative for patients failing primary radiation or cryotherapy. However, larger studies with longer-term data are required.
authors.affiliation: Sloan-Kettering Institute, Memorial Sloan-Kettering Cancer Center, New York 10065, USA.
authors.forename: Youness
authors.initials: Y
authors.lastname: Ahallal
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Daher C
authors.initials: DC
authors.lastname: Chade
authors.forename: Clarisse
authors.initials: C
authors.lastname: Mazzola
authors.forename: Victor E
authors.initials: VE
authors.lastname: Reuter
authors.forename: Jaspreet S
authors.initials: JS
authors.lastname: Sandhu
authors.forename: Vincent P
authors.initials: VP
authors.lastname: Laudone
authors.forename: Karim A
authors.initials: KA
authors.lastname: Touijer
authors.forename: Bertrand D
authors.initials: BD
authors.lastname: Guillonneau
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood*; D005240:Feasibility Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000276:immunology / Q000532:radiotherapy / Q000601:surgery*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen