Robot-assisted post-chemotherapy retroperitoneal lymph node dissection in germ cell tumor: is the single-docking with lateral approach relevant?

Abstract

Surgical treatment of post-chemotherapy residual mass of germ cell tumor (GCT) may be performed in various techniques. We assess the feasibility, safety, and efficacy of single-docking with lateral approach robot-assisted retroperitoneal lymph node dissection (R-RPLND) in residual mass of GCT in our center. A retrospective review of patients undergoing R-RPLND for residual mass of CGT was performed between January 2014 and April 2017. Patients with residual mass <3cm for seminoma or <1cm for non-seminoma were eligible. All surgeries were performed with single-docking RPNLD technique in lateral decubitus. We assessed preoperative characteristics (age, testicular pathology, template, chemotherapy regimen, lesion size, and clinical stage), peroperative (operative time, estimated blood loss, intraoperative complication, node count, pathology, and number of positive node), and postoperative outcomes (postoperative complications, hospital length of stay, recurrence-free survival at 2year, and ejaculation dysfunction). Eleven patients underwent R-RPLND with a median size of the residual mass of 20mm. Median operative time was 153min with 120ml of estimated blood loss, without intraoperative complication. Median nodes count was 7 [1; 24]. Two patients had post-chemotherapy necrotic nodes and one no tumorous node. One patient had postoperative Clavien I complication (chyloperitoneum). We report 72.7% of antegrade ejaculation at 1month from the surgery. Median clinical recurrence-free survival was 100% after 2years from the surgery (n=6). Lateral approach with single-docking R-RPLND for residual mass of GCT is feasible and safe, with satisfying functional and oncologic outcomes.