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Robotic Primary RPLND for Stage I Testicular Cancer: a Review of Indications and Outcomes

  • Heather J. ChalfinEmail author
  • Wesley Ludwig
  • Phillip M. Pierorazio
  • Mohamad E. Allaf
Minimally Invasive Surgery (T Guzzo, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Minimally Invasive Surgery

Abstract

Patients diagnosed with stage I non-seminomatous germ cell tumor (NSGCT) face the task of selecting a management strategy. Whereas these options all offer excellent survival, unfortunately, each has drawbacks. Retroperitoneal lymph node dissection (RPLND) is a major operation with low, but significant risks of bleeding, chylous ascites, and retrograde ejaculation. Platinum-based chemotherapy is associated with a number of long-term side effects, not all of which are quantified, but include secondary malignancy and early cardiovascular disease. While surveillance minimizes the chances of exposure to unnecessary treatment, it is not infrequently salvaged with chemotherapy and requires a compliant patient willing to undergo serial imaging often with ionizing radiation. Although fewer than one-third of patients will relapse without intervention, the current guidelines propose treatment for stage I patients with high-risk features. New developments in minimally invasive techniques may mitigate the harms of RPLND and avoid the side effects of chemotherapy, making it an ideal option for this cohort of patients. Unlike laparoscopic RPLND, which was introduced as a staging procedure and heavily criticized for the advanced skill set required to achieve oncologic equivalence, robotic RPLND may offer the benefits of a minimally invasive technique without a steep learning curve and a true therapeutic operation in experienced hands.

Keywords

RPLND Robotics Minimally invasive Testis cancer 

Notes

Compliance with Ethical Standards

Conflict of Interest

Heather J. Chalfin, Wesley Ludwig, Phillip M. Pierorazio, and Mohamad E. Allaf each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Supplementary material

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Heather J. Chalfin
    • 1
    Email author
  • Wesley Ludwig
    • 1
  • Phillip M. Pierorazio
    • 1
  • Mohamad E. Allaf
    • 1
  1. 1.The James Buchanan Brady Urological Institute and Department of UrologyJohns Hopkins University School of MedicineBaltimoreUSA

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