Primary robotic RLPND for nonseminomatous germ cell testicular cancer: a two-center analysis of intermediate oncologic and safety outcomes
To evaluate the intermediate-term oncologic outcomes and safety profile of the largest case series of primary robotic retroperitoneal lymphadenectomy for low-clinical-stage non-seminomatous germ cell testicular cancer.
This was a two-center retrospective analysis of robotic RPLND cases for low-clinical-stage (stage I–IIB) non-seminomatous germ cell testicular cancer in the primary setting. Demographic, perioperative, operative and oncologic variables were collected between March 2008 and May 2019. Descriptive analyses were performed and presented as medians with interquartile ranges for continuous variables and frequency and proportions for categorical variables. A survival analysis of time to recurrence was performed using Cox proportional hazards model. Using logistic regression, risk factors for complications were analyzed. Both univariate and multivariate analyses were performed.
A total of 58 patients (CS 1 = 56, CS IIA = 2, CS IIB = 0) were identified. The median follow-up was 47 months and the 2-year recurrence-free survival rate was 91%. The five recurrences were all out of the performed dissection template (pelvis = 1 and lung = 4). Only five patients (29%) with occult metastasis underwent adjuvant chemotherapy. The median operative time was 319 min [interquartile range (IQR) 276–355 min], estimated blood loss was 100 ml (IQR 75–200 ml), node count was 26 (IQR 20–31), and length of stay 2 d (IQR 1–3 days). There were 2 (3.3%) intraoperative complications, 19 (32.7%) 30-day postoperative complications to include 14 (24.1%) Clavien grade I, 4 (6.9%) Clavien grade II, 1 (1.7%) Clavien grade III and 0 Clavien grade IV complications. No statistical significance was found on multivariate or univariate analysis for survival analysis of time to recurrence and risk factors for complications.
This study represents the largest case series of primary R-RPLND for the treatment of low-stage non-seminomatous germ cell tumors (NSGCT). With 47 months of follow-up and a low rate of adjuvant chemotherapy, intermediate oncologic efficacy appears to be comparable to the gold standard open approach.
KeywordsTesticular cancer Retroperitoneal lymph node dissection Robotic surgery RPLND NSGCT
NRR: data collection or management, data analysis, and manuscript writing/editing. SPS: protocol/project development, data analysis, and manuscript writing/editing. HMA: data collection or management, data analysis. MTM: data analysis and manuscript writing/editing. MGS: data collection or management, data analysis, and manuscript writing/editing. MSC: data analysis and manuscript writing/editing. JOL’: protocol/project development. EPC: protocol/project development and manuscript writing/editing.
Compliance with ethical standards
Conflict of interest
SPS, MGS, and JOL have served as surgical proctors for Intuitive Surgical, Inc.
All procedures performed in this retrospective study involving human participants were in accordance with the ethical standards of the NMCSD Institutional Review Board (NMCSD.2012.0155) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
A waiver of informed consent was granted for this retrospective registry study in accordance with ethical standards and after approval of the NMCSD Institutional Review Board (NMCSD.2012.0155).
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