To evaluate the perioperative and oncological/functional outcomes of robotic post-chemotherapy retroperitoneal lymph node dissection for testicular cancer.
In this retrospective study, we included patients who underwent robotic post-chemotherapy retroperitoneal lymph node dissection at 7 academic centers between 2011 and 2021. Patients' characteristics, perioperative findings, as well as oncological and functional outcomes are reviewed. Relationships with the main outcome (90-day complications) were analyzed using multivariable logistic regression.
A total of 90 patients with a median (IQR) age of 30 (25-37) years were included. The main primary histologic type was non-seminomatous germ cell tumor (89%). Seven patients (8%) were electively converted to open. Median estimated blood loss, operative time, and length of hospital stay were 150 ml, 5.6 hours, and 2 days, respectively. Final pathology revealed teratoma in 49 (55%), necrosis/fibrosis in 29 (32%), and viable germ cell tumor in 12 (13%) patients. The 90-day complication rate was 16.7%, most of which were low-grade (Clavien-Dindo < III) and managed conservatively. On multivariable analysis, pure seminoma (odds ratio 17.4) and bilateral dissection template (odds ratio 4.2) were independently associated with 90-day complications. No 90-day hospital readmission was recorded. With a median (IQR) follow-up of 16 (4-32) months, 6 (6.7%) patients had disease recurrence and there was 1 cancer-related death.
With appropriate patient selection at centers with expertise in testicular cancer and minimally invasive surgery, robotic post-chemotherapy retroperitoneal lymph node dissection appears safe and effective, although longer follow-up is warranted.
Urologic oncology. 2022 Nov 24 [Epub ahead of print]
Alireza Ghoreifi, Anirban P Mitra, George McClintock, Fady Baky, Zachary McDowell, Etienne Lavallée, Ragheed Saoud, Jie Cai, Inderbir S Gill, John Sfakianos, James Porter, Aditya Bagrodia, Nariman Ahmadi, Scott Eggener, John F Ward, Hooman Djaladat
Institute of Urology, University of Southern California, Los Angeles, CA., Department of Urology and Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA., Department of Urology, Chris O'Brien Lifehouse, Sydney, NSW, Australia., Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX., Swedish Urology Group, Seattle, WA., Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY., Department of Surgery, Section of Urology, University of Chicago, Chicago, IL., Department of Urology, UC San Diego School of Medicine, La Jolla, CA., Institute of Urology, University of Southern California, Los Angeles, CA. Electronic address: .