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. 2022 Apr;16(2):369-375.
doi: 10.1007/s11701-021-01252-1. Epub 2021 May 12.

Robotic retroperitoneal lymph node dissection for primary and post-chemotherapy testis cancer

G J Nason  1 , K Kuhathaas  1 , L Anson-Cartwright  1 , M A S Jewett  1 , M O'Malley  2 , J Sweet  3 , A Hansen  4 , P Bedard  4 , P Chung  5 , E Hahn  5 , P Warde  5 , R J Hamilton  6
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Robotic retroperitoneal lymph node dissection for primary and post-chemotherapy testis cancer

G J Nason et al. J Robot Surg. 2022 Apr.

Abstract

The role of retroperitoneal lymph node dissection (RPLND) in testicular cancer is well established in both the primary and post-chemotherapy setting. The aim of this study was to report our 2 years oncological outcomes of robotic RPLND. A retrospective review was performed of all patients undergoing robotic RPLND by a single surgeon at Princess Margaret Cancer Centre. Demographic, perioperative, and oncologic data were analyzed using descriptive statistics. Between September 2014 and June 2020, 141 patients underwent an RPLND [33 (23.4%) were primary, 108 (76.6%) were post-chemotherapy]. 27 (19.1%) patients underwent a robotic bilateral template nerve-sparing RPLND. RPLND indication was primary (i.e. pre-chemotherapy) in 18 (66.7%), and post-chemotherapy in 9 (33.3%) patients. Stage at RPLND was 2A (n = 15, 55.6%), 2B (n = 9, 33.3%), 2C (n = 1, 3.7%) and 3 (n = 2, 7.4%). Median OR time (incision to closure) was 525 min and blood loss was 200 ml. Nerve sparing was performed in all but one case. Six (22.2%) adjuvant procedures were performed including two (7.4%) vascular repairs. Median length of stay was 2 days. Viable tumor was detected in 17 (63%) and teratoma in 9 (33.3%). Median follow-up was 31.3 months. No adjuvant chemotherapy was given. Three patients (11.1%) relapsed: 2 out-of-field and 1 with both in-field and out-of-field disease. Robotic RPLND can be performed safely. Long-term follow-up of series such as ours, enriched with patients with viable disease and/or teratoma, and not treated with adjuvant chemotherapy is required to ensure oncological outcomes are comparable to the open approach.

Keywords: Germ cell tumor; RPLND; Robotic; Testis cancer.

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References

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    1. Shayegan B, Carver BS, Stasi J et al (2007) Clinical outcome following post-chemotherapy retroperitoneal lymph node dissection in men with intermediate- and poor-risk nonseminomatous germ cell tumour. BJU Int 99(5):993–997 - DOI

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