Previous pelvic surgery should not be considered a contraindication to robotic or open radical prostatectomy (RP), researchers reported in the Korean Journal of Urology (2015;56:131-137).
“Robotic or open RP is feasible and can achieve good overall results in patients who have previously undergone pelvic surgery,” the investigators concluded.
Mahmoud Mustafa, MD, of An-Najah National University Hospital in Nablus, Palestine, and colleagues at MD Anderson Cancer Center in Houston studied 64 men with a median age of 65 years who underwent RP after previous pelvic surgery of the large intestine. Of these, 24 (37.5%) underwent robotic RP and 40 (62.5%) underwent open RP. The median period between previous pelvic surgery and RP was 8 years.
Thirteen patients had positive surgical margins, 6 patients had seminal vesicle involvement, and 2 had lymph node involvement. The researchers observed no intraoperative complications. There were no conversions from robotic to open RP. Postoperative complications included bowel obstruction and persistent bladder leakage in 2 patients, lymphocele in 1 patient, and urethral stricture in 1 patient.
In addition, 88% of patients were continent at 7 months and 80% were able to achieve an erection with or without medical aid.
The authors explained that previous surgery or radiotherapy in the pelvic region can result in fibrous scarring that alters tissue layers, thereby making it more difficult to perform RP.