Salvage radical prostatectomy for recurrent prostate cancer: morbidity and functional outcomes from a large multicenter series of open versus robotic approaches

Paolo Gontero, Giancarlo Marra, Paolo Alessio, Claudia Filippini, Marco Oderda, Fernando Munoz, Estefania Linares, Rafael Sanchez-Salas, Ben Challacombe, Prokar Dasgupta, Sanchia Goonewardene, Rick Popert, Declan Cahill, David Gillatt, Raj Persad, Juan Palou, Steven Joniau, Thierry Piechaud, Alessandro Morlacco, Sharma ViditMorgan Rouprêt, Alexandre De La Taille, Simone Albisinni, Giorgio Gandaglia, Alexander Mottrie, Shreyas Joshi, Gabriel Fiscus, Andre Berger, Monish Aron, Henk Van Der Poel, Derya Tilki, Nathan Lawrentschuk, Declan G. Murphy, Gordon Leung, John Davis, Robert Jeffrey Karnes, Collaborators

Research output: Contribution to journalArticlepeer-review

64 Citations (Scopus)


Purpose: Salvage radical prostatectomy has historically yielded a poor functional outcome and a high complication rate. However, recent reports of robotic salvage radical prostatectomy have demonstrated improved results. In this study we assessed salvage radical prostatectomy functional outcomes and complications when comparing robotic and open approaches. Materials and Methods: We retrospectively collected data on salvage radical prostatectomy for recurrent prostate cancer after local nonsurgical treatment at 18 tertiary referral centers from 2000 to 2016. The Clavien-Dindo classification was applied to classify complications. Complications and functional outcomes were evaluated by univariable and multivariable analysis. Results: We included 395 salvage radical prostatectomies, of which 186 were open and 209 were robotic. Robotic salvage radical prostatectomy yielded lower blood loss and a shorter hospital stay (each p <0.0001). No significant difference emerged in the incidence of major and overall complications (10.1%, p=0.16, and 34.9%, p=0.67), including an overall low risk of rectal injury and fistula (1.58% and 2.02%, respectively). However, anastomotic stricture was more frequent for open salvage radical prostatectomy (16.57% vs 7.66%, p <0.01). Overall 24.6% of patients had had severe incontinence, defined as 3 or more pads per day, for 12 or 6 months. On multivariable analysis robotic salvage radical prostatectomy was an independent predictor of continence preservation (OR 0.411, 95% CI 0.232-0.727, p=0.022). Limitations include the retrospective nature of the study and the absence of a standardized surgical technique. Conclusions: In this contemporary series to our knowledge salvage radical prostatectomy showed a low risk of major complications and better functional outcomes than previously reported. Robotic salvage radical prostatectomy may reduce anastomotic stricture, blood loss and hospital stay, and improve continence outcomes.

Original languageEnglish
Pages (from-to)725-731
Number of pages7
JournalJournal of Urology
Issue number4
Publication statusPublished - 1 Oct 2019
Externally publishedYes


  • local
  • neoplasm recurrence
  • prostatectomy
  • prostatic neoplasms
  • robotic surgical procedures
  • treatment outcome


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