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Indications, feasibility and outcome of robotic retroperitoneal lymph node dissection for metastatic testicular germ
Carsten-Henning Ohlmann1,2,3, Matthias Saar2, Laura-Christin Pierchalla1
1Department of Urology, Malteser Krankenhaus Seliger Gerhard, Bonn, Rhein-Sieg, Germany.
Abstract:
Data on robotic retroperitoneal lymph node dissection (R-RPLND) for metastatic testicular germ cell tumours (mTGCTs) are scarce and the use of R-RPLND itself is still under debate. The aim of our study was to evaluate the indications, feasibility and outcomes of R-RPLND, with special emphasis on differences between primary R-RPLND (pR-RPLND) and post-chemotherapeutic R-RPLND (pcR-RPLND) in mTGCTs. We retrospectively analysed the data of patients who underwent R-RPLND for mTGCT between November 2013 and September 2019 in two centres in Germany. Indications, operative technique, intra- and postoperative complications and oncologic outcome were analysed. Twenty-three mTGCT patients underwent R-RPLND (7 pR-RPLND, 16 pcR-RPLND). For pR-RPLND versus pcR-RPLND, median time of surgery was 243 min [interquartile range (IQR) 123-303] versus 359 min (IQR 202-440, p = 0.154) and median blood loss 100 mL (IQR 50-200) versus 275 mL (IQR 100-775, p = 0.018). Intra- and postoperative complications were more frequent in pcR-RPLND (pcR-RPLND: intra/post: 44%/44%; pR-RPLND: intra/post: 0%/29%). However, these were only statistically significant in the case of intraoperative complications (intra: p = 0.036, post: p = 0.579). Intraoperative complications (n = 7), conversions (n = 4) and transfusions (n = 4) occurred in pcR-RPLND patients only. After a median follow-up of 16.3 months (IQR 7.5-35.0) there were no recurrences or deaths. R-RPLND displays a valuable, minimally invasive treatment option in mTGCT. However, R-RPLND is challenging and pcR-RPLND especially bears a considerable risk of complications. This operation should be limited to patients with an easily accessible residual tumour mass and to surgeons experienced in robotic surgery and TGCT treatment.
Insights
Robotic retroperitoneal lymph node dissection (R-RPLND) is a valuable minimally invasive option for metastatic testicular germ cell tumors (mTGCTs). However, post-chemotherapy R-RPLND carries significant complication risks and requires experienced surgeons.
Area of Science:
- Urology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Data on robotic retroperitoneal lymph node dissection (R-RPLND) for metastatic testicular germ cell tumors (mTGCTs) are limited.
- The role and safety of R-RPLND, particularly in comparison to primary (pR-RPLND) versus post-chemotherapy (pcR-RPLND) settings, remain debated.
Purpose of the Study:
- To evaluate the indications, feasibility, and outcomes of R-RPLND in mTGCT patients.
- To specifically compare outcomes and complication rates between primary R-RPLND (pR-RPLND) and post-chemotherapy R-RPLND (pcR-RPLND).
Main Methods:
- Retrospective analysis of 23 mTGCT patients who underwent R-RPLND between November 2013 and September 2019 across two German centers.
- Data collected included indications, surgical technique, intraoperative and postoperative complications, and oncologic outcomes.
- Patients were categorized into primary R-RPLND (n=7) and post-chemotherapy R-RPLND (n=16) groups for comparative analysis.
Main Results:
- Post-chemotherapy R-RPLND (pcR-RPLND) showed significantly higher median blood loss (275 mL vs. 100 mL) and a trend towards longer surgery duration compared to pR-RPLND.
- Intraoperative complications (7/16 vs. 0/7) and conversions to open surgery (4/16 vs. 0/7) occurred exclusively in the pcR-RPLND group, with intraoperative complications being statistically significant (p=0.036).
- No recurrences or deaths were observed at a median follow-up of 16.3 months, indicating favorable oncologic outcomes for R-RPLND in selected mTGCT patients.
Conclusions:
- Robotic retroperitoneal lymph node dissection (R-RPLND) is a viable minimally invasive treatment for mTGCTs.
- Post-chemotherapy R-RPLND (pcR-RPLND) is associated with increased operative complexity and a higher risk of complications.
- R-RPLND for mTGCT should be reserved for patients with accessible residual tumors and performed by surgeons experienced in robotic surgery and TGCT management.
