Introduction: We aimed to report the morbidity profile of salvage radical prostatectomy (SRP) and assess the impact of minimally invasive surgery (MIS) on postoperative complications and functional outcomes.
Methods: A total of 293 patients underwent SRP; 232 underwent open SRP and 61 underwent laparoscopic SRP with or without robotic assistance. Complications were recorded and classified into standardized categories. Cancer-specific survival (CSS) and overall survival (OS) were estimated with the Kaplan-Meier method.
Results: Twenty-nine patients (10%) experienced grade 3 complications within 30 days, 22 (9.5%) after open and 7 (11%) after MIS (difference = -2%; 95% C.I. -11%, 7%; p=0.6). Between 30 to 90 days after surgery, 7.3% of patients in the open group and 10% in the MIS group had grade 3 complications (difference = -2.5%; 95% C.I. -11%, 6%; p = 0.5). The most common complication was bladder neck contracture (BNC), representing 40% of the 30–90 day complications. Within one year of SRP, 81 patients (31%, 95% C.I. 25%, 37%) developed BNC; we saw non-significant lower rates in MIS (25% vs 32%; p=0.4). Five year CSS and OS was 95% and 88% for the entire cohort, respectively.
Conclusions: Our outcomes suggest poor functional recovery after SRP, regardless of the operative approach. Currently there is no evidence favoring the use of open or MIS approach. Further studies are required to ensure comparable outcomes between these approaches.
Source of Funding: This work was supported by the Sidney Kimmel Center for Prostate and Urologic Cancers at MSK, the NIH/NCI grant P50 CA092629, and the NIH/NCI Cancer Center Support Grant to Memorial Sloan Kettering Cancer Center (P30 CA008748). Marlon Perera is sponsored by the Australian-America Fulbright Commission administered through a 2021-2022 Fulbright Future Scholarship funded by The Kinghorn Foundation.