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Primary robotic RLPND for nonseminomatous germ cell testicular cancer: a two-center analysis of intermediate oncologic and safety outcomes

  • Nicholas R. Rocco
  • Sean P. StroupEmail author
  • Haidar M. Abdul-Muhsin
  • Michael T. Marshall
  • Michael G. Santomauro
  • Matthew S. Christman
  • James O. L’Esperance
  • Erik P. Castle
Topic Paper

Abstract

Objective

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Testicular cancer Retroperitoneal lymph node dissection Robotic surgery RPLND NSGCT 

Notes

Author contributions

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.

Funding

None.

Compliance with ethical standards

Conflict of interest

SPS, MGS, and JOL have served as surgical proctors for Intuitive Surgical, Inc.

Ethical approval

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.

Informed consent

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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Copyright information

© This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2019

Authors and Affiliations

  • Nicholas R. Rocco
    • 1
  • Sean P. Stroup
    • 1
    Email author
  • Haidar M. Abdul-Muhsin
    • 2
  • Michael T. Marshall
    • 1
  • Michael G. Santomauro
    • 1
  • Matthew S. Christman
    • 1
  • James O. L’Esperance
    • 1
  • Erik P. Castle
    • 2
  1. 1.Department of UrologyNaval Medical Center San DiegoSan DiegoUSA
  2. 2.Department of UrologyMayo ClinicPhoenixUSA

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