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Comparative Study
. 2022 Jan;40(1):119-126.
doi: 10.1007/s00345-021-03832-0. Epub 2021 Oct 1.

A comparative study of peri-operative outcomes for 100 consecutive post-chemotherapy and primary robot-assisted and open retroperitoneal lymph node dissections

Paul Lloyd #  1 , Anne Hong #  2 , Marc A Furrer  2   3   4 , Elaine W Y Lee  1 , Harveer S Dev  1 , Maurice H Coret  1 , James M Adshead  5 , Peter Baldwin  6 , Richard Knight  1 , Jonathan Shamash  7 , Constantine Alifrangis  8 , Sara Stoneham  8 , Danish Mazhar  9 , Han Wong  9 , Anne Warren  10 , Ben Tran  11   12 , Nathan Lawrentschuk  2   13 , David E Neal  1 , Benjamin C Thomas  14   15   16   17
Affiliations
Comparative Study

A comparative study of peri-operative outcomes for 100 consecutive post-chemotherapy and primary robot-assisted and open retroperitoneal lymph node dissections

Paul Lloyd et al. World J Urol. 2022 Jan.

Abstract

Purpose: To describe and compare differences in peri-operative outcomes of robot-assisted (RA-RPLND) and open (O-RPLND) retroperitoneal lymph node dissection performed by a single surgeon where chemotherapy is the standard initial treatment for Stage 2 or greater non-seminomatous germ cell tumour.

Methods: Review of a prospective database of all RA-RPLNDs (28 patients) and O-RPLNDs (72 patients) performed by a single surgeon from 2014 to 2020. Peri-operative outcomes were compared for patients having RA-RPLND to all O-RPLNDs and a matched cohort of patients having O-RPLND (20 patients). Further comparison was performed between all patients in the RA-RPLND group (21 patients) and matched O-RPLND group (18 patients) who had previous chemotherapy. RA-RPLND was performed for patients suitable for a unilateral template dissection. O-RPLND was performed prior to the introduction of RA-RPLND and for patients not suitable for RA-RPLND after its introduction.

Results: RA-RPLND showed improved peri-operative outcomes compared to the matched cohort of O-RPLND-median blood loss (50 versus 400 ml, p < 0.00001), operative duration (150 versus 195 min, p = 0.023) length-of-stay (1 versus 5 days, p < 0.00001) and anejaculation (0 versus 4, p = 0.0249). There was no statistical difference in complication rates. RA-RPLND had lower median lymph node yields although not significant (9 versus 13, p = 0.070). These improved peri-operative outcomes were also seen in the post-chemotherapy RA-RPLND versus O-RPLND analysis. There were no tumour recurrences seen in either group with median follow-up of 36 months and 60 months, respectively.

Conclusions: Post-chemotherapy RA-RPLND may have decreased blood loss, operative duration, hospital length-of-stay and anejaculation rates in selected cases and should, therefore, be considered in selected patients. Differences in oncological outcomes require longer term follow-up.

Keywords: Retroperitoneal lymph node dissection; Robotic surgery; Testicular cancer.

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References

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