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.
Highlights
Data on robotic retroperitoneal lymph node dissection (R-Retroperitoneal lymph node dissection (RPLND)) for metastatic testicular germ cell tumours are scarce and the use of R-RPLND itself is still under debate
The results of our series of patients demonstrate the feasibility of R-RPLND for a wide range of indications, as well as the differently challenging character of pR-RPLND compared to pcRRPLND, with acceptable morbidity and excellent early oncologic efficacy in metastatic testicular germ cell tumours (mTGCTs) patients
As indications for pR-RPLND in clinical stage (CS) 1 disease, due to the nowadays most often applied treatment options of surveillance or one cycle of chemotherapy, have almost vanished, our study shows the wide indications for R-RPLND in mTGCT in a real-world setting2,3,5
Summary
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 (pcRRPLND) 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. R-RPLND is challenging and pcR-RPLND especially bears a considerable risk of complications This operation should be limited to patients with an accessible residual tumour mass and to surgeons experienced in robotic surgery and TGCT treatment. We evaluated the indications, feasibility and outcomes of R-RPLND in mTGCT, with special emphasis on differences between pR-RPLND and pcR-RPLND
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