Indications, feasibility and outcome of robotic retroperitoneal lymph node dissection for metastatic testicular germ cell tumours

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.

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

“…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.…”

“…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].…”

“…Overall, 271 patients underwent primary R‐RPLND. Tables 1 and 2 [6,21–37] describe the demographic and clinical characteristics and the perioperative outcomes in these patients, most of whom had NSGCT (88.9%, 241/271). Among 271 patients undergoing primary R‐RPLND, 23.2% (63/271) had Stage II disease and 31% (84/271) patients underwent bilateral dissection.…”

“…Overall, 271 patients underwent primary R-RPLND. Tables 1 and 2 [6,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] describe the demographic and clinical characteristics and the perioperative outcomes in these patients, most of whom had NSGCT (88.9%, 241/271). Among 271 patients undergoing primary R-RPLND, 23.2% (63/271) (Table 1).…”

“…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.…”