Perioperative Outcomes of Salvage Radical Prostatectomy After Radiation Therapy: A Nationwide Analysis Using the National Clinical Database of Japan.

backgroundSalvage radical prostatectomy (sRP) is a potentially curative treatment for localized recurrence after radiation therapy for prostate cancer; however, nationwide real-world perioperative outcomes remain unclear.

methodsWe conducted a retrospective descriptive study using the Japanese National Clinical Database (NCD). Patients who underwent sRP after radiation therapy were identified, and perioperative, functional, and pathological outcomes were summarized descriptively according to surgical approach and prior radiation modality without comparative statistical analysis.

resultsA total of 162 patients were included. The median age was 71 years, and high-risk features were common (Gleason score ≥ 8, 49.4%; pathological stage ≥ pT3, 45.7%). Robot-assisted surgery was performed in 88.3% of cases. The median operative time was 254.5 min, and estimated blood loss was 101 mL. Blood transfusion was required in 4.3% of patients. Major complications (Clavien-Dindo grade ≥ III) occurred in 4.9%, with one postoperative death (0.6%). Operative time and blood loss tended to be higher in patients with prior BT than EBRT, whereas major complication rates were comparable. Positive surgical margins were observed in 24.1%, and extraprostatic extension in 36.4%. Early continence recovery was limited, with 27.2% of patients using 0-1 pad/day at 1 month.

conclusionsThis nationwide NCD study provides contemporary real-world data regarding perioperative outcomes after salvage radical prostatectomy in Japan. Although perioperative morbidity appeared acceptable in appropriately selected patients, these findings should be interpreted descriptively because formal comparative analyses were not performed.