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Published on: February 12, 2022
Robotic-assisted retroperitoneal lymph node dissection for stage II testicular cancer
George McClintock1, Ahmed S Goolam1, Don Perera2
1Department of Urology, Chris O'Brien Lifehouse, Sydney, NSW, Australia.
Objective:
To evaluate the perioperative as well as early oncological outcomes of patients undergoing robotic retroperitoneal lymph node dissection for treatment of testicular cancer.
Methods:
We conducted a prospective consecutive case series of patients undergoing robotic assisted retroperitoneal lymph node dissection for metastatic testicular cancer between May 2018 and July 2021 at our institution. Data were collected on patient and tumour characteristics, intraoperative and postoperative parameters, and functional and oncological outcomes. Descriptive statistics are presented.
Results:
Nineteen patients were identified; 18 (94.7%) completed the procedure robotically and one was converted to open surgery; 78.9% of patients had stage ≥IIB and 12 (63.2%) patients had undergone prior chemotherapy. The median operative time was 300 (interquartile range [IQR] 240-315) min. Median blood loss was 100 (IQR 50-175) mL. Median length of stay was 2 (range 1-11) days. All robotically completed patients commenced diet and passed flatus on Day 1 and were discharged by Day 3. The median lymph node yield was 40.5 (IQR 38-51) nodes. All patients undergoing nerve-sparing procedures recovered antegrade ejaculatory function. One patient had a Clavien-Dindo III complication (chylous ascites requiring drainage). At a median follow-up of 22.3 (IQR 16.3-24.9) months, one patient developed retroperitoneal recurrence, which was successfully treated with second-line chemotherapy; no other patients have had recurrences.
Conclusion:
Robotic retroperitoneal lymph node dissection is a safe and feasible alternative to open surgery in appropriately selected patients, offering low morbidity. Early oncological outcomes are promising. Larger cohorts and longer follow-ups are required to validate our institution's findings.
Insights
Robotic retroperitoneal lymph node dissection for testicular cancer is safe and effective, with promising early oncological results and low complication rates. This minimally invasive approach offers a viable alternative to open surgery for selected patients.
Area of Science:
- Urology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Testicular cancer often requires retroperitoneal lymph node dissection (RPLND) for treatment.
- Open RPLND can be associated with significant morbidity.
- Robotic-assisted surgery offers potential advantages in terms of precision and recovery.
Purpose of the Study:
- To evaluate the perioperative and early oncological outcomes of robotic retroperitoneal lymph node dissection (RPLND) in patients with testicular cancer.
- To assess the safety and feasibility of this minimally invasive approach.
Main Methods:
- A prospective consecutive case series of 19 patients with metastatic testicular cancer undergoing robotic-assisted RPLND.
- Data collected included patient/tumor characteristics, intraoperative/postoperative parameters, and functional/oncological outcomes.
- Descriptive statistics were used to analyze the data.
Main Results:
- 18 of 19 patients completed the robotic procedure; median operative time was 300 minutes, with median blood loss of 100 mL.
- Median length of stay was 2 days, with rapid return to diet and ambulation for robotically treated patients.
- Nerve-sparing procedures preserved antegrade ejaculatory function in all patients; one Clavien-Dindo III complication (chylous ascites) occurred.
- At a median follow-up of 22.3 months, only one patient had a recurrence, successfully treated with chemotherapy.
Conclusions:
- Robotic RPLND is a safe and feasible alternative to open surgery for selected testicular cancer patients, demonstrating low morbidity.
- Early oncological outcomes are promising, suggesting effectiveness in disease control.
- Larger studies and longer follow-up are needed to confirm these findings.
