The feasibility and safety of a robotic approach for postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) in testicular cancer have been demonstrated, but data on long-term oncological outcomes of this procedure are limited. Our aim was to evaluate oncological outcomes following robotic PC-RPLND in this setting.
This retrospective cohort study included consecutive patients with testicular cancer treated with robotic PC-RPLND at 11 academic centers worldwide between 2011 and 2023. Patient characteristics, clinicopathological findings, and oncological outcomes were recorded. Recurrence-free survival (RFS) was estimated via the Kaplan-Meier method.
A total of 173 patients were included, of whom 159 underwent pure robotic PC-RPLND; 14 cases were converted to open surgery. Among the pure robotic cases, 152 (96%) had nonseminoma, 122 (77%) had International Germ Cell Cancer Collaborative Group good risk, and 120 (76%) had a postchemotherapy mass size ≤5 cm. Salvage chemotherapy was received by ten patients (6%). Median estimated blood loss, operative time, and length of hospital stay were 100 ml, 300 min, and 2 d, respectively. Final pathology revealed necrosis/fibrosis in 64 cases (40%), teratoma in 78 (49%), and viable germ-cell tumor in 17 (11%). At median follow-up of 22 mo (interquartile range 7-50), eight patients had disease recurrence, which was in-field in three cases. One port-site recurrence was identified. The median time to recurrence was 7 mo. The 4-yr RFS rate was 93%. Two cancer-related deaths were recorded. Subgroup analysis revealed that patients with conversion to open surgery were more likely to have a larger preoperative mass and received salvage chemotherapy before RPLND. In addition, conversion to open surgery was associated with a higher rate of perioperative complications; however, oncological outcomes were statistically similar to those for pure robotic PC-RPLND. The main limitation of the study is its retrospective nature.
Robotic PC-RPLND in testicular cancer is associated with acceptable intermediate-term oncological outcomes in appropriately selected patients.
In this large multicenter study, we investigated the outcomes of robotic surgery after chemotherapy for advanced testicular cancer. We found that robotic surgery yields acceptable cancer control results.
European urology focus. 2024 Nov 16 [Epub ahead of print]
Alireza Ghoreifi, Farshad Sheybaee Moghaddam, Anirban P Mitra, Ashish Khanna, Amitabh Singh, Julian Chavarriaga, Sol C Moon, Ahmed Saeed Goolam, Ryan Chuang, Jordan M Rich, Fady J Baky, Matthew Ho, Jacob Roberts, Inderbir S Gill, James R Porter, Nariman Ahmadi, Reza Mehrazin, John P Sfakianos, Soroush Rais-Bahrami, Aditya Bagrodia, Robert J Hamilton, Scott Eggener, Sudhir Rawal, John F Ward, Hooman Djaladat
Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA., Department of Urology and Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA., Department of Uro-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India., Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada., Department of Urology, Heersink School of Medicine, University of Alabama, Birmingham, AL, USA., Department of Urology, Chris O'Brien Lifehouse, Sydney, Australia., Swedish Medical Group, Seattle, WA, USA., Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA., Department of Surgery, Section of Urology, University of Chicago, Chicago, IL, USA., Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA., Department of Urology, Heersink School of Medicine, University of Alabama, Birmingham, AL, USA; Department of Radiology, Heersink School of Medicine, University of Alabama, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, Heersink School of Medicine, University of Alabama, Birmingham, AL, USA., Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA., Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. Electronic address: .