Abstract
Robotic-assisted laparoscopic retroperitoneal lymph node dissection in post chemotherapy residual mass in testis cancer Introduction: The laparoscopic retroperitoneal lymph node dissection (L-RPLND) has shown results at least comparable to open surgery in terms of perioperative complications and oncological results, but its application in the post chemotherapy scenario is still matter of study. The development of robotic surgery and its advantages over laparoscopic surgery, make this an attractive option for complex procedures. We report our initial experience with robotic-assisted retroperitoneal lymph node dissection (R-RPLND). Methods: We describe the cases of two patients who underwent R-RPLND due to a Post Chemotherapy residual mass of a non-seminomatous testicular cancer. Results: Two patients, 27 and 30 years old, presented with retroperito- neal residual mass after 4 and 6 cycles of Bleomicin, Etoposide and Cis-Platinum. The fi rst patient had a 4.3 cm left para-aortic mass and the other had a 6 cm mass behind the third portion of the duodenum. The mean surgical time was 255 minutes (210-300), with an estimated mean blood loss of 450 cc (100-800) and a mean hospital stay of 60 hours (72-48). The pathologic result was Teratoma in both cases. There was no periopera- tive morbidity. Conclusions: We believe that R-RPLND is a feasible and safe alternative in selected patients. However still needs more experience and longer follow up to asess its oncological outcome.
Highlights
The laparoscopic retroperitoneal lymph node dissection (L-RPLND) has shown results at least comparable to open surgery in terms of perioperative complications and oncological results, but its application in the post chemotherapy scenario is still matter of study
We report our initial experience with robotic-assisted retroperitoneal lymph node dissection (R-RPLND)
We describe the cases of two patients who underwent R-RPLND due to a Post Chemotherapy residual mass of a non-seminomatous testicular cancer
Summary
The laparoscopic retroperitoneal lymph node dissection (L-RPLND) has shown results at least comparable to open surgery in terms of perioperative complications and oncological results, but its application in the post chemotherapy scenario is still matter of study. Métodos: Describimos el caso de dos pacientes sometidos a una a una linfadenectomía retroperitoneal lumboaórtica asistida por robot (LRLA-R), portadores de una masa retroperitoneal postquimioterapia secundaria a un carcinoma testicular de células germinales no seminoma. Conclusiones: Creemos que la LRLA-R en pacientes con masa residual post-quimioterapia es una técnica reproducible y segura en pacientes seleccionados, sin embargo, todavía es necesario un mayor número de pacientes y tiempos de seguimiento para poder evaluar los resultados oncológicos. La linfadenectomía retroperitoneal lumboaórtica abierta (LRLA-A) es el método de elección en muchos centros para el manejo de pacientes con tumores testiculares de células germinales no seminoma. Al agregar una visión tridimensional, un mayor rango de movimiento y la ausencia de temblor, la cirugía robóticamente asistida se convierte en una opción atractiva para procedimientos de mayor complejidad como la linfadenectomía retroperitoneal lumboaórtica en pacientes con masa residual postquimioterapia. Presentamos 2 casos clínicos de pacientes sometidos a una LRLA-R por masa residual retroperitoneal luego de tratamiento quimioterápico por cáncer testicular avanzado, que hasta donde sabemos son los primeros casos reportados en Latinoamérica y el 4o y 5o reportados en la literatura mundial
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