Outcomes of post-chemotherapy robot-assisted retroperitoneal lymph node dissection in testicular cancer: multi-institutional study

• Published in: World journal of urology 2021-10, Vol.39 (10), p.3833-3838
• Main Authors: Abdul-Muhsin, Haidar, Rocco, Nicholas, Navaratnam, Anojan, Woods, Michael, L’Esperance, James, Castle, Erik, Stroup, Sean
• Format: Article
• Language: English
• Subjects: Adult; Carcinoma, Embryonal - drug therapy; Carcinoma, Embryonal - pathology; Carcinoma, Embryonal - surgery; Chemotherapy; Convalescence; Dissection; Ejaculation; Endodermal Sinus Tumor - drug therapy; Endodermal Sinus Tumor - pathology; Endodermal Sinus Tumor - surgery; Fibrosis; Humans; Induction Chemotherapy; Lymph Node Excision - methods; Lymph nodes; Lymphatic system; Male; Medicine; Medicine & Public Health; Morbidity; Neoplasm Staging; Neoplasms, Germ Cell and Embryonal - drug therapy; Neoplasms, Germ Cell and Embryonal - pathology; Neoplasms, Germ Cell and Embryonal - surgery; Nephrology; Oncology; Orchiectomy; Organ Sparing Treatments; Original Article; Patients; Postoperative Complications - epidemiology; Retroperitoneal Space - surgery; Retrospective Studies; Robotic surgery; Robotic Surgical Procedures - methods; Seminoma - drug therapy; Seminoma - pathology; Seminoma - surgery; Sexual Dysfunction, Physiological - epidemiology; Teratoma; Teratoma - drug therapy; Teratoma - pathology; Teratoma - surgery; Testes; Testicular cancer; Testicular Neoplasms - drug therapy; Testicular Neoplasms - pathology; Testicular Neoplasms - surgery; Urology; Young Adult
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-021-03712-7

Objective To evaluate the perioperative and oncological outcomes after post-chemotherapy robot-assisted retroperitoneal lymph node dissection (PC-RARPLND). Materials and methods We retrospectively reported the perioperative and oncological outcomes of all the patients with testicular cancer who underwent PC-RARPLND at three tertiary teaching centers. Descriptive statistical measures were used to report demographic, clinical, intraoperative, postoperative and oncological outcomes. Results There were 43 consecutive patients who underwent PC-RARPLND at the participating institutions. Mean patient age was 29.2 years (± 8.2), BMI was 26.6 kg/m 2 (± 6.2). The mean size of retroperitoneal mass was 4.1 cm (± 3.5). Full bilateral template dissection was performed in 38 (88.3%) patients. Nerve sparing was attempted in 19 (44.1%) patients. Mean operative time was 374 min (± 132) and estimated blood loss was 292 ml (± 445.6). The mean postoperative LOS was 2.8 days (± 5.9). There was a total of 12 complications in 10 patients (Clavien grade I = 5, II = 3, III = 3 and IV = 1). Postoperative pathology demonstrated 24 patients (55%) with necrosis/fibrosis, 16 (37%) with teratoma and 3 (7%) with viable tumor. Mean lymph node (LN) yield was 26.5 LNs (SD ± 16.1). Patients were followed for a mean of 30.7 months (± 24.7). No deaths were documented during follow-up and 2 pulmonary recurrences were identified. Antegrade ejaculation was preserved in 70.6% of patient who underwent nerve sparing. Limitations included retrospective nature and limited follow up. Conclusion PC-RAPLND is safe and technically reproducible. It provides improved morbidity and less convalescence.