LAUSR

PURPOSE Salvage radical prostatectomy (sRP) historically yields poor functional outcomes and high complication rates. However, recent reports on robotic sRP have demonstrated improved results. In this study, we assessed sRP functional outcomes and complications, comparing robotic and open approaches. MATERIALS AND METHODS We retrospectively collected data of sRP for recurrent prostate cancer (PCa) after local non-surgical treatment at 18 tertiary referral centers, from 2000 to 2016. The Clavien-Dindo classification was employed to classify complications. Complications and functional outcomes were evaluated in a uni- and multivariable analysis. RESULTS We included 395 sRP (n=186 open; n=209 robotic). The robotic-sRP yielded lower BL (p<0.0001) and shorter HS (p<0.0001). No significant differences emerged in major (10.1%, p=0.16) and overall complications (34.9%, p=0.67), including an overall low risk of rectal injuries and fistulas (1.58% and 2.02% respectively); however, anastomotic stricture was more frequent for open-sRP (16.57% vs 7.66%; p<0.01). Overall 24.6% had severe (≥3pads/day) incontinence (12 or 6mo). On multivariable analysis robotic-sRP was an independent predictor for continence preservation (OR 0.411, 95% CI 0.232-0.727, p=0.022). Limitations include the retrospective nature and absence of standardized surgical technique. CONCLUSIONS In a contemporary series, sRP showed a low risk of major complications and better functional outcomes than previously reported. Robotic-sRP may reduce anastomotic strictures, blood loss, and hospital stay, and improve continence outcomes.