ABSTRACT Purpose: Salvage robotic-assisted radical prostatectomy (S-RARP) has gained prominence in recent years for treating patients with cancer recurrence following non-surgical treatments of Prostate Cancer. We conducted a systematic literature review to evaluate the role and outcomes of S-RARP over the past decade. Materials and Methods: A systematic review was conducted, encompassing articles published between January 1st, 2013, and June 1st, 2023, on S-RARP outcomes. Articles were screened according to PRISMA guidelines, resulting in 33 selected studies. Data were extracted, including patient demographics, operative times, complications, functional outcomes, and oncological outcomes. Results: Among 1,630 patients from 33 studies, radiotherapy was the most common primary treatment (42%). Operative times ranged from 110 to 303 minutes, with estimated blood loss between 50 to 745 mL. Intraoperative complications occurred in 0 to 9% of cases, while postoperative complications ranged from 0 to 90% (Clavien 1-5). Continence rates varied (from 0 to 100%), and potency rates ranged from 0 to 66.7%. Positive surgical margins were reported up to 65.6%, and biochemical recurrence ranged from 0 to 57%. Conclusion: Salvage robotic-assisted radical prostatectomy in patients with cancer recurrence after previous prostate cancer treatment is safe and feasible. The literature is based on retrospective studies with inherent limitations describing low rates of intraoperative complications and small blood loss. However, potency and continence rates are largely reduced compared to the primary RARP series, despite the type of the primary treatment. Better-designed studies to assess the long-term outcomes and individually specify each primary therapy impact on the salvage treatment are still needed. Future articles should be more specific and provide more details regarding the previous therapies and S-RARP surgical techniques. Purpose roboticassisted robotic assisted SRARP S (S-RARP nonsurgical non Cancer decade Methods 1st st 2013 2023 guidelines 3 extracted demographics Results 1630 1 630 1,63 42%. 42 42% . (42%) 11 30 minutes 5 74 mL 9 cases 90 Clavien 15. 15 1-5) 100%, 100 100% , 100%) 667 66 7 66.7% 656 65 6 65.6% 57 57% Conclusion feasible However series Betterdesigned Better designed longterm long term needed techniques 201 202 163 63 1,6 4 (42% 1-5 10 66.7 65.6 20 16 1, (42 1- 66. 65. 2 (4 (

ABSTRACT Objectives: Within the tertiary-case database, the authors tested for differences in long-term continence rates (≥ 12 months) between prostate cancer patients with extraprostatic vs. organ-confined disease who underwent Robotic-Assisted Radical Prostatectomy (RARP). Method: In the institutional tertiary-care database the authors identified prostate cancer patients who underwent RARP between 01/2014 and 01/2021. The cohort was divided into two groups based on tumor extension in the final RARP specimen: patients with extraprostatic (pT3/4) vs. organ-confined (pT2) disease. Additionally, the authors conducted subgroup analyses within both the extraprostatic and organ-confined disease groups to compare continence rates before and after the implementation of the new surgical technique, which included Full Functional-Length Urethra preservation (FFLU) and Neurovascular Structure-Adjacent Frozen-Section Examination (NeuroSAFE). Multivariable logistic regression models addressing long-term continence were used. Results: Overall, the authors identified 201 study patients of whom 75 (37 %) exhibited extraprostatic and 126 (63 %) organ-confined disease. There was no significant difference in long-term continence rates between patients with extraprostatic and organ-confined disease (77 vs. 83 %; p = 0.3). Following the implementation of FFLU+ NeuroSAFE, there was an overall improvement in continence from 67 % to 89 % (Δ = 22 %; p < 0.001). No difference in the magnitude of improved continence rates between extraprostatic vs. organ-confined disease was observed (Δ = 22 % vs. Δ = 20 %). In multivariable logistic regression models, no difference between extraprostatic vs. organ-confined disease in long-term continence was observed (Odds Ratio: 0.91; p = 0.85). Conclusion: In this tertiary-based institutional study, patients with extraprostatic and organ-confined prostate cancer exhibited comparable long-term continence rates. Objectives tertiarycase tertiary case longterm long term ≥ ( 1 months vs organconfined organ confined RoboticAssisted Robotic Assisted RARP. . (RARP) Method tertiarycare care 012014 01 2014 01/201 012021 2021 01/2021 specimen pT3/4 pT34 pT pT3 4 (pT3/4 pT2 (pT2 Additionally technique FunctionalLength Functional Length FFLU (FFLU StructureAdjacent Structure Adjacent FrozenSection Frozen Section NeuroSAFE. NeuroSAFE (NeuroSAFE) used Results Overall 7 37 (3 63 (6 77 (7 8 0.3. 03 0.3 0 3 0.3) 6 2 0.001. 0001 0.001 001 0.001) %. Odds Ratio 0.91 091 91 0.85. 085 0.85 85 0.85) Conclusion tertiarybased (RARP 01201 01/20 01202 202 01/202 pT3/ (pT3/ (pT (NeuroSAFE 0. 000 0.00 00 0.9 09 9 08 0.8 0120 01/2 (pT3 0.0 012 01/