Morbidity and mortality of salvage radical prostatectomy for prostate cancer: An analysis of the National surgical quality improvement program targeted prostatectomy database.

Introduction/background: For men with local recurrence of prostate cancer following radiotherapy, salvage radical prostatectomy (SRP) may be considered. However, SRP is associated with increased risk of surgical complications and patient selection is critical. To quantify this contemporary risk and identify predictive factors, we performed a retrospective cohort study utilizing the NSQIP targeted radical prostatectomy (RP) dataset.

Methods: We identified adult patients undergoing robotic-assisted RP from 2019 to 2022 using the NSQIP database. The primary outcome was the rates of procedure-specific outcomes such as rectal injury, urinary leak or fistula, gastrointestinal (GI) leak/injury, prolonged postoperative nil per os (NPO) or nasogastric tube (NGT) use, and development of lymphoceles. Secondary outcomes included major postoperative outcomes. RP and SRP groups were balanced using propensity score matching.

Results: Among 27,280 patients, SRP was associated with an increased risk of urinary leak or fistula (OR 3.94, 95% CI 1.85-8.39), GI injury (OR 1.80, 95% CI 1.09-2.98) and prolonged postoperative NPO or NG tube use (OR 5.15, 95% CI 2.24-11.83). SRP was associated with higher surgical site infections (SSI) (OR 3.17, 95% CI 1.60-6.30) and unplanned readmission (OR 2.43, 95% CI 1.33-4.44). Subgroup analysis identified an increased risk of urinary leak associated with SRP in those with a BMI >25 and age ≥65.

Conclusion: SRP was associated with a 3-fold risk of SSI, 3-fold risk of leak/fistula and a 2-fold risk of unplanned readmission. Obese and elderly patients were more likely to experience urinary leak. These data can be used to optimize patients and select those who will benefit from SRP.