title: Preliminary analysis of the feasibility and safety of salvage robot-assisted radical prostatectomy after radiation failure: multi-institutional perioperative and short-term functional outcomes.
abstract: OBJECTIVE
  Open radical prostatectomy after radiation treatment failure for prostate cancer is associated with significant morbidity. The purpose of the study is to report multi-institutional experiences while performing salvage robot-assisted radical prostatectomy (sRARP).
  
  
  METHODS
  We retrospectively identified 15 patients with biopsy-proven prostate cancer after definitive radiotherapy who underwent sRARP in three academic institutions over a 20-month period. Continence was defined as the use of 0 pads after surgery. Potency was defined as the ability to achieve erections adequate enough for penetration with or without the use of phosphodiesterase-5 inhibitors. Biochemical recurrence after sRARP was defined as a prostate-specific antigen value of >0.2  ng/mL.
  
  
  RESULTS
  Radiation treatment consisted of external-beam radiation therapy (XRT) in five cases, interstitial radioactive 125-iodine brachytherapy (BT) in five cases, proton beam therapy in two cases, and XRT followed by interstitial radioactive 125-iodine BT in three cases. The median operative time, the median estimated blood loss, and the median length of hospital stay were 140.5  min (interquartile range [IQR] 97.5-157  min), 75  mL (IQR 50-100  mL), and 1 day (IQR 1-2 d), respectively. There were no rectal injuries. Two (13.3%) patients had a positive surgical margin. A total of three (20%) patients had postoperative complications. One patient had a deep vein thrombosis (Clavien grade II), one had wound infection (Clavien grade II), and one patient had an anastomotic leak (Clavien gradeId). An anastomotic stricture (Clavien grade IIIa) later developed in this same patient, which was managed by direct visual internal urethrotomy. Of the patients, 71.4% were continent. At a median follow-up of 4.6 months (IQR 3-9.75 mos), four (28.6%) patients presented with biochemical recurrence after sRARP.
  
  
  CONCLUSIONS
  The challenge during sRALP is the presence of extensive fibrosis and loss of dissection planes secondary to radiation therapy. It is a technically challenging but feasible procedure. The early complication rates were low, and early continence rates are encouraging.
authors.affiliation: Global Robotics Institute, Florida Hospital-Celebration Health, University of Central Florida School of Medicine, Celebration, Florida, USA.
authors.forename: Sanket
authors.initials: S
authors.lastname: Chauhan
authors.forename: Manoj B
authors.initials: MB
authors.lastname: Patel
authors.forename: Rafael
authors.initials: R
authors.lastname: Coelho
authors.forename: Michael
authors.initials: M
authors.lastname: Liss
authors.forename: Bernardo
authors.initials: B
authors.lastname: Rocco
authors.forename: Ananth K
authors.initials: AK
authors.lastname: Sivaraman
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Palmer
authors.forename: Geoffrey D
authors.initials: GD
authors.lastname: Coughlin
authors.forename: Robert G
authors.initials: RG
authors.lastname: Ferrigni
authors.forename: Erik P
authors.initials: EP
authors.lastname: Castle
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Ahlering
authors.forename: Eduard
authors.initials: E
authors.lastname: Parra-Davila
authors.forename: Vipul R
authors.initials: VR
authors.lastname: Patel
mesh_terms: D000368:Aged; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011183:Postoperative Complications / Q000209:etiology; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000503:physiopathology* / Q000532:radiotherapy* / Q000601:surgery; D012007:Rectum / Q000473:pathology; D012371:Robotics / Q000379:methods*; D016879:Salvage Therapy; D013997:Time Factors; D017211:Treatment Failure