Robotic retroperitoneal lymphadenectomy in paratesticular rhabdomyosarcoma

Abstract

Paratesticular sarcoma is an aggressive malignanttumor of mesenchymal origin. The rhabdomyosarcoma is the most common among children.Rhabdomyosarcoma treatment consists ofsurgery, chemotherapy and radiotherapy. Prognosicdepends on local recurrence and distant metastasis. We present the case of a 16-year-old male, who inApril 2016 underwent right radical orchiectomy surgery by testicular mass rapidly evolving, with pathological results indicating a paratesticular rhabdomyosarcoma. The extension study showed aprecaval adenopathy suggestive of lymph nodemetastasis, therefore it was a high-grade rhabdomyosarcoma. There was an appropriate response after chemotherapy (Protocol EpSSG RMS2005) andwe decided to perform a robotic lymphadenectomy. We performed a transperitoneal approach with 8mm trocar and 12mm optica trocar. We accessed the retroperitoneal space through a latero-colic incision. Then we performed a craniocaudal lymph node dissection until the aortic bifurcation. The surgical time was 240min with a blood loss of 200ml. There were no complications. The patient was discharged on the fourth day after surgery. Pathology showed metastasis of rhabdomyosarcoma without capsular rupture. After two months, we placed the left testicle into inguinal canal prior to radiotherapy. Robotic lymph node metastasis lymphadenectomy from paratesticular sarcomas is a feasible treatment with the advantage of minimally invasive surgery and acceptable morbidity.