Abstract
PurposeTo evaluate the outcome of robot-assisted residual mass resection (RA-RMR) in nonseminomatous germ cell tumor (NSGCT) patients with residual tumor following chemotherapy.Patients and methodsRetrospective medical chart analysis of all patients with NSGCT undergoing RA-RMR at two tertiary referral centers between January 2007 and April 2019. Patients were considered for RA-RMR in case of a residual tumor between 10 and 50 mm at cross-sectional computed tomography (CT) imaging located ventrally or laterally from the aorta or vena cava, with normalized tumor markers following completion of chemotherapy, and no history of retroperitoneal surgery.ResultsA total of 45 patients were included in the analysis. The Royal Marsden stage before chemotherapy was IIA in 13 (28.9%), IIB in 16 (35.6%), IIC in 3 (6.7%) and IV in 13 patients (28.9%). The median residual tumor size was 1.9 cm (interquartile range [IQR] 1.4–2.8; range 1.0–5.0). Five procedures (11.1%) were converted to an open procedure due to a vascular injury (n = 2), technical difficulty (n = 2) or tumor debris leakage (n = 1). A postoperative adverse event occurred in two patients (4.4%). Histopathology showed teratoma, necrosis and viable cancer in 29 (64.4%), 14 (31.1%), and two patients (4.4%), respectively. After a median follow-up of 41 months (IQR 22–70), one patient (2.2%) relapsed in the retroperitoneum. The one- and 2-year recurrence-free survival rate was 98%.ConclusionRA-RMR is an appropriate treatment option in selected patients, potentially providing excellent cure rates with minimal morbidity. Long-term outcome data are needed to further support this strategy and determine inclusion and exclusion criteria.
Highlights
One-third of patients who undergo cisplatin-based combination chemotherapy for disseminated nonseminomatous germ cell tumor (NSGCT) have significant residual retroperitoneal disease [1, 2]
Since there are currently no validated methods to reliably predict the histology of a residual mass, PC-RPLND remains important in all patients with significant residual disease in NSGCT [5]
Bilateral template-based retroperitoneal lymph node dissection was the standard approach in all patients undergoing PC-RPLND [5]
Summary
One-third of patients who undergo cisplatin-based combination chemotherapy for disseminated nonseminomatous germ cell tumor (NSGCT) have significant residual retroperitoneal disease [1, 2]. Bilateral template-based retroperitoneal lymph node dissection was the standard approach in all patients undergoing PC-RPLND [5]. A template-based procedure is the standard approach, several centers consider residual mass resection as oncologically equivalent [6, 7]. Patients were considered for RA-RMR in case of one or two residual tumors between 10 and 50 mm at cross-sectional CT imaging located ventrally or laterally from the aorta or vena cava, with normalized tumor markers following completion of chemotherapy, and no history of retroperitoneal surgery. Follow-up was performed according to current guidelines of the European Society for Medical Oncology This consisted of monthly clinical examinations and evaluations of serum tumor markers in the first year. Abdominal/thoracic CT scanning was done at least three times (after 6, 12 and 24 months)
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