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

Abstract

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.

The Availability, Cost, Limitations, Learning Curve and Future of Robotic Systems in Urology and Prostate Cancer Surgery

“…Robot-assisted partial nephrectomy has been associated with a reduced rate of conversion to open surgery compared to a laparoscopic approach, a reduced length of stay and a smaller reduction in glomerular filtration rate [ 13 ]. Robotic RPLND has been associated with reduced overall complication rate and reduced blood transfusion compared to open RPLND, but there was a 9% rate of conversion to open surgery in post-chemotherapy patients [ 14 ].…”

Case of the Month from University of Melbourne, Australia: refractory chyle leak after retroperitoneal lymph node dissection with updated algorithm

“…Retroperitoneal lymph node dissection (RPLND) is an important part of multimodal therapy for node‐positive germ cell malignancy [1–4]. However, due to wide heterogeneity in patient status, disease biology and tumour locations, RPLND can be challenging and risky [1]. One such risk is iatrogenic chylous ascites (CA; 8% of cases) [1].…”

“…However, due to wide heterogeneity in patient status, disease biology and tumour locations, RPLND can be challenging and risky [1]. One such risk is iatrogenic chylous ascites (CA; 8% of cases) [1]. CA is defined as accumulation of chyle, a lipid‐rich lymph fluid in the peritoneal cavity [5].…”

“…This morbidity impairs postoperative recovery, delays adjuvant oncological therapy, and detrimentally affects quality of life [2,4]. Limited reliable data exist to describe the management of this complex condition [1]. We outline a difficult case and then review the literature for treatment strategies and propose a contemporary management algorithm for refractory post‐RPLND CA.…”