Introduction: Isolated recurrences of prostate cancer (PCa) have become a more frequent entity with the widespread use of more sensitive imaging modalities. In a growing number of patients, local recurrences in (remnants of) seminal vesicles (SV) emerge. Most of these are within an operated and/or radiated zone, leading to start of androgen-deprivation therapy (ADT) as one of the only options. Salvage vesiculectomy is hypothesized to be a potential curative treatment in these patients. The main objective of this study is to describe this new surgical approach (open and robot-assisted). We further report peri- and postoperative complications and early outcomes. Methods: This retrospective multicenter study includes 108 patients with solitary recurrence in the SV between January 2009 and June 2022. Patients with local recurrences outside the SV or with concomitant metastatic disease were excluded. Both SV (or the remnants) were resected using an open or a robot-assisted approach. In selected cases, a concomitant lymphadenectomy (LND) was performed. The surgical technique of both approaches is explained in the accompanying video. Results: Our population had a median age of 68 years at the time of surgery with a median pre-operative PSA of 2.7 ng/ml. 74 patients (68.52%) were primary treated with a radical prostatectomy (RP) and 34 patients (31.48%) with radiotherapy (EBRT or brachytherapy). 40% (n = 42) of patients had a concomitant LND. There was a median follow-up of 14 months. Up until 90 days after surgery, 28.70% (n = 31) had any peri- and/or postoperative complication. These were all but one grade 1 to 3 on the Clavien-Dindo Classification. Most complications occurred within the first month after surgery (n = 20). Most were low grade. All complications can be found in Table 1. A median PSA decrease of 2.07 ng/ml (IQR: 0.80 - 4.33, p < 0.001), translating into a median reduction of 92.10% (IQR: 59.34% - 98.32%) compared to the pre-operative value is reported. Freedom from secondary treatment was 53.51% at the end of follow-up. Conclusions: This multicenter, retrospective study shows that salvage vesiculectomy for solitary prostate cancer recurrence limited to the seminal vesicle (remnants) is a generally safe procedure in patients with otherwise limited possibilities other than systemic therapy. SOURCE OF Funding: None
