Faculty Collaboration Database

Primary Robot-assisted Retroperitoneal Lymph Node Dissection for Men with Nonseminomatous Germ Cell Tumor: Experience from a Multi-institutional Cohort. Eur Urol Focus 2021 Nov;7(6):1403-1408

Date

07/20/2020

Pubmed ID

32682794

DOI

10.1016/j.euf.2020.06.014

Scopus ID

2-s2.0-85087965545 (requires institutional sign-in at Scopus site)   6 Citations

Abstract

BACKGROUND: Primary robot-assisted retroperitoneal lymph node dissection (RA-RPLND) for men with nonseminomatous germ cell tumor (NSGCT) is an alternative to open RPLND for stage I and select stage II patients.

OBJECTIVE: To report the complication rates and oncologic outcomes from a multi-institutional series, and to estimate reduction in chemotherapy by using upfront minimally invasive surgery.

DESIGN, SETTING, AND PARTICIPANTS: A retrospective chart review of men undergoing primary robot-assisted RPLND between 2014 and 2019 in five institutions by eight urologists experienced in testis cancer and robotic surgery.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Variables such as demographic and clinicopathologic information, operative parameters and complication rates, oncologic outcomes, sexual recovery, and hospital length of stay were collected. Descriptive statistics are presented.

RESULTS AND LIMITATIONS: Forty-nine patients were analyzed with a median follow-up of 15.0 mo (interquartile range 6.5-29.1 mo). Median operative time was 288 min, estimated blood loss was 100 ml, and lymph node yield was 32. Median length of stay was 1 d. There were nine postoperative complications, 44% (4/9) of which were Clavien grade 1. There were no Clavien grade IV complications. Twenty-one patients had metastatic NSGCT (42.8%), of whom nine (18.4%) received adjuvant chemotherapy. Four patients experienced recurrence (three out-of-field and one in-field recurrence). Limitations include the retrospective study design and various surgical techniques among surgeons.

CONCLUSIONS: Primary robot-assisted RPLND for NSGCT can be performed safely, with low complication rates and acceptable oncologic outcomes reducing the need for chemotherapy. For a population in which compliance with surveillance is typically challenging, robot-assisted RPLND may improve quality of care and outcomes for patients with NSGCT.

PATIENT SUMMARY: In experienced centers, robot-assisted retroperitoneal lymph node dissection can be performed safely with similar oncologic outcomes to an open approach, while providing an option that may reduce the need for chemotherapy.

Author List

Taylor J, Becher E, Wysock JS, Lenis AT, Litwin MS, Jipp J, Langenstroer P, Johnson S, Bjurlin MA, Tan HJ, Lane BR, Huang WC

Authors

Scott C. Johnson MD Associate Professor in the Urologic Surgery department at Medical College of Wisconsin
Peter Langenstroer MD Professor in the Urologic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Humans
Lymph Node Excision
Male
Neoplasms, Germ Cell and Embryonal
Retroperitoneal Space
Retrospective Studies
Robotics
Testicular Neoplasms