Outcomes of post-chemotherapy robot-assisted retroperitoneal lymph node dissection in testicular cancer: multi-institutional study

Abdul-Muhsin, Haidar; Rocco, Nicholas R; Navaratnam, Anojan; Woods, Michael; L’Esperance, James O.; Castle, Erik P.; Stroup, Sean P.

doi:10.1007/s00345-021-03712-7

Cited by 10 publications

(7 citation statements)

References 32 publications

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Section: Resultsmentioning

confidence: 99%

“…A total of 37 studies [7,21–56] were included. Of these, 12 studies [7,21,23–25,28–32,34,35] described patients who underwent primary R‐RPLND only, 16 [38–53] described patients who underwent post‐chemotherapy R‐RPLND only, and six [22,26,27,33,36,37] included patients who underwent R‐RPLND in either of these settings. Two studies involving post‐chemotherapy RPLND were published from the same centre at two different time periods [39,41]; hence, the series published on a later date was included in the cumulative analysis [41].…”

Section: Resultsmentioning

confidence: 99%

“…Data for 188 patients who underwent post‐chemotherapy R‐RPLND was analysed. Tables 3 and 4 [22,26,27,33,36–38,40–53] describe the demographic and clinical characteristics of these patients and their perioperative outcomes. NSGCT was the most common indication for surgery (94.7%, 178/188).…”

Section: Resultsmentioning

confidence: 99%

“…3B). Currently, the platform most used for R-RPLND is the da Vinci â Xi, and most contemporary series report the outcomes of R-RPLND in either the supine [32,34,36,50,53] or flank [33][34][35]52] position. However, there has been no direct comparison of outcomes between the supine and flank approaches, and the choice of patient positioning remains at the surgeon's discretion.…”

Section: Flank Vs Supine Trendelenburg Positioningmentioning

confidence: 99%

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Robot‐assisted retroperitoneal lymph node dissection: a systematic review of perioperative outcomes

Garg¹,

Mansour²,

Psutka

et al. 2023

BJU International

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To assess the safety and feasibility of robot-assisted retroperitoneal lymph node dissection (R-RPLND) and to compare the perioperative outcomes of R-RPLND with open RPLND (O-RPLND), as RPLND forms an integral part of the management of testis cancer and R-RPLND is a minimally invasive treatment option for this disease. Materials and MethodsThe PubMed â , Scopus â , Cochrane Central Register of Controlled Trials, and Web of Science TM databases were searched for studies reporting perioperative outcomes of primary and post-chemotherapy R-RPLND and studies comparing R-RPLND with O-RPLND. ResultsThe search yielded 42 articles describing R-RPLND, including five comparative studies. The systematic review included 4222 patients (single-arm studies, n = 459; comparative studies, n = 3763). Of 459 patients in the single-arm studies, 271 underwent primary R-RPLND and 188 underwent post-chemotherapy R-RPLND. For primary R-RPLND, the operative time ranged from 175 to 540 min and the major complication rate was 4.1%. For post-chemotherapy R-RPLND, the operative time ranged from 134 to 550 min and the major complication rate was 8.5%. The conversion rate to open surgery was 2.2% in primary R-RPLND and 9.0% in post-chemotherapy R-RPLND. In comparison with O-RPLND, R-RPLND was associated with a lower transfusion rate (14.5% vs 0.9%, P < 0.001) and a lower complication rate (18.5% vs 7.8%, P = 0.002). ConclusionRobot-assisted RPLND has acceptable perioperative outcomes in both the primary and post-chemotherapy settings but a notable rate of conversion to open surgery in the post-chemotherapy setting. Compared with O-RPLND, R-RPLND is associated with a lower transfusion rate and fewer overall complications. Given the potential impact of selection bias, the optimal patient selection criteria for R-RPLND remain to be elucidated.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Flank Vs Supine Trendelenburg Positioningmentioning

confidence: 99%

See 2 more Smart Citations

Robot‐assisted retroperitoneal lymph node dissection: a systematic review of perioperative outcomes

Garg¹,

Mansour²,

Psutka

et al. 2023

BJU International

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“…The advantages are its ability to perform full bilateral template RPLND without redocking, and ipsilateral spermatic cord resection. Multiple series adopting the supine approach have been recently published with encouraging results [23,24 ▪ ,53,54,55 ▪▪ ,56,57]. The benefits included low major perioperative complications (4%), decreased estimated blood loss, and similar nodal yield with a low length of stay (1.3 days) from a recent meta-analysis [58].…”

Section: Surgical Nerve Spare Techniquesmentioning

confidence: 99%

Nerve-sparing technique in RPLND for testicular cancer

Nalavenkata

Patel

2023

Current Opinion in Urology

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Purpose of reviewThe management of testicular cancer has evolved over time with multimodal therapy. Retroperitoneal lymph node dissection (RPLND), which is a complex and potentially morbid treatment option, remains the mainstay in surgical treatment. This article reviews the surgical template, approach and anatomical considerations with regards to nerve spare in RPLND. Recent findingsThe standard full bilateral RPLND template has evolved over time to include the area between the renal hilum, bifurcation of the common iliac vessels, and the ureters. Morbidity with regards to ejaculatory dysfunction has led to further refinements in this procedure. Advancements in anatomical understanding of the retroperitoneal structures and their relationship to the sympathetic chain and hypogastric plexus has allowed for modification of surgical templates. Further refinements in surgical nerve sparing techniques have improved functional outcomes without sacrificing oncological outcomes. Finally, extraperitoneal access to the retroperitoneum and minimally invasive platforms have been implemented to further reduce morbidity. SummaryRPLND requires strict adherence to oncological surgical principles regardless of template, approach and technique. Contemporary evidence shows that outcomes are best for advanced testis cancer patients when managed at high volume tertiary care facilities with surgical expertise and access to multidisciplinary care.

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Re: Lloyd P, Hong A, Furrer MA, et al. A comparative study of perioperative outcomes for 100 consecutive post-chemotherapy and primary robot assisted and open retroperitoneal lymph node dissections. World J Urol. 2021; DOI: 10.1007/s00345-021-03832-0

Ghoreifi

Djaladat²

2022

World J Urol

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Outcomes of post-chemotherapy robot-assisted retroperitoneal lymph node dissection in testicular cancer: multi-institutional study

Cited by 10 publications

References 32 publications

Robot‐assisted retroperitoneal lymph node dissection: a systematic review of perioperative outcomes

Robot‐assisted retroperitoneal lymph node dissection: a systematic review of perioperative outcomes

Nerve-sparing technique in RPLND for testicular cancer

Re: Lloyd P, Hong A, Furrer MA, et al. A comparative study of perioperative outcomes for 100 consecutive post-chemotherapy and primary robot assisted and open retroperitoneal lymph node dissections. World J Urol. 2021; DOI: 10.1007/s00345-021-03832-0

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