Robot-assisted retroperitoneal lymphadenectomy: The state of art

Abstract

Objective To perform a narrative review about the role of robot-assisted retroperitoneal lymphadenectomy (R-RPLND) in the management of testicular cancer. Methods A PubMed search for all relevant publications regarding the R-RPLND series up until August 2019 was performed. The largest series were identified, and weighted means calculated for outcomes using the number of patients included in each study as the weighting factor. Results Fifty-six articles of R-RPLND were identified and eight series with more than 10 patients in each were included. The weighted mean age was 31.12 years; primary and post chemotherapy R-RPLND were performed in 50.59% and 49.41% of patients. The clinical stage was I, II and III in 47.20%, 39.57% and 13.23% of patients. A modified R-RPLND template was used in 78.02% of patients, while 21.98% underwent bilateral full template. The weighted mean node yield, operative time and estimated blood loss were, respectively, 22.15 nodes, 277.35 min and 131.94 mL. The weighted mean length of hospital stay was 2 days and antegrade ejaculation was preserved in 92.12% of patients. Major post-operative complications (Clavien III or IV) occurred in 5.34%. Positive pathological nodes were detected in 24.54%, while the recurrence free survival was 95.77% with a follow-up of 21.81 months. Conclusion R-RPLND has proven to be a reproducible and safe approach in experienced centers; short-term oncologic outcomes are similar to the open approach with less morbidity and shorter convalescence related to its minimal invasiveness. However, longer follow-up and new trials comparing head-to-head both techniques are expected.

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.…”

“…The robotic surgical platform was introduced in the early 2000s and the first robot-assisted RPLND (R-RPLND) was described by Davol et al [6]. The robotic approach has helped to reap the benefits of minimally invasive surgical techniques and has the advantages of a shortened learning curve with improved visualisation, instrument dexterity, and better ergonomics [7][8][9][10]. R-RPLND is an emerging treatment option and there have been several reports on its outcomes.…”

A meta-analysis of clinicopathologic features that predict necrosis or fibrosis at post-chemotherapy retroperitoneal lymph node dissection in individuals receiving treatment for non-seminoma germ cell tumours

“…Meanwhile, pcRPLND continues to be a cornerstone of management for patients with NSGCT with residual masses ( 65 , 66 ) erring on the side of over-treatment and preservation of cure. Historically, an open pcRPLND ensuring complete resection within a short time frame from the end of chemotherapy has been the preferred approach; however, robotic strategies are increasingly utilised in some centres to limit specific post-operative complications, such as the length of stay and post-operative pain and ileus ( 12 , 67 ), but require an ongoing prospective evaluation to ensure equivalent oncologic outcomes. Regardless of the surgical strategy, referral to a high-volume centre specialising in pcRPLND is strongly recommended ( 8 ) to aid in clinical decision-making, limit potential complications, and improve the chances of a cure.…”

Testicular tumors in the “elderly” population

“…We have no information in the elderly population regarding retroperitoneal lymph node dissection in such patients from large mono-institutional series or reviews (14,15). However, such procedure is recommended in a limited number of GCT patients, according to guidelines.…”