Surgical navigation for targeted retroperitoneal lymph-node removal: a randomised, controlled, phase 3 trial

Area of Science:

• Oncology
• Surgical Technology
• Medical Imaging

Background:

• Metastatic retroperitoneal lymph node dissection (LND) is crucial for managing nodal recurrence in various cancers, including urological, gynaecological, and rectal types.
• Precise localization and resection of retroperitoneal lymph nodes (LNs) can be challenging, particularly after prior radiotherapy or surgery.
• Assessing the added value of surgical navigation for targeted LND in the retroperitoneum is essential for improving surgical efficacy.

Purpose of the Study:

• To evaluate the effectiveness of surgical navigation in improving the success rate of targeted retroperitoneal lymph node dissection (LND).
• To compare the outcomes of LND performed with surgical navigation versus conventional methods in patients with suspected nodal recurrence.

Main Methods:

• A phase 3, open-label, randomised controlled trial was conducted involving patients scheduled for targeted retroperitoneal LND.
• Patients were randomised to receive either conventional LND or LND using surgical navigation, which involved creating a 3D anatomical model from CT scans.
• Success was defined as the absence of residual target lymph nodes on postoperative CT imaging.

Main Results:

• The success rate for surgical procedures was significantly higher in the navigation arm (85%) compared to the conventional arm (50%) (p=0.0028).
• The overall complication rates were comparable between the two groups, as assessed by the Clavien-Dindo classification.
• Surgeons reported a positive perception of surgical navigation, with a median preference score of 3.7 and a median system usability score of 75.

Conclusions:

• Surgical navigation offers a significant advantage in the precise localization and removal of target lymph nodes in the retroperitoneum.
• The integration of surgical navigation technology enhances the efficacy of LND procedures for cancer recurrence.
• This technology holds promise for improving surgical outcomes in managing metastatic retroperitoneal lymph nodes.