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Oncological Outcomes Following Robotic Postchemotherapy Retroperitoneal Lymph Node Dissection for Testicular Cancer: A Worldwide Multicenter Study - Beyond the Abstract

Post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) is a complex surgery that has traditionally been performed through an open approach. The feasibility of a robotic approach has been demonstrated in recent years, aiming to improve perioperative and functional outcomes.1 In lieu of these studies, the recent AUA guidelines suggest that the robotic approach can be offered to selected patients by expert surgeons.2 However, one of the concerns about the robotic PC-RPLND is the absence of long-term oncological outcome data. We tried to address this in a large, international, multicenter study.3

A total of 173 patients from 11 academic centers worldwide have been included in this retrospective cohort study. Of these, 96% were cases of non-seminomatous GCTs, 77% were classified as IGCCCG good risk, and 76% presented with post-chemotherapy masses measuring less than 5 cm. This aligns with expert opinions, which recommend selecting patients with a lower clinical stage, more favorable IGCCCG classification, and a marked response to chemotherapy for robotic PC-RPLND. The final pathology revealed necrosis/fibrosis in 40%, teratoma in 49%, and viable germ cell tumor in 11%. Eight patients had disease recurrence following surgery, including three in-field, with no significant link to clinicopathological factors. The 4-year recurrence-free survival (RFS) rate was 93%.

Our study is the first to investigate the predictors and outcomes of open conversion during robotic PC-RPLND. The conversion rate was 8%, with higher risk in patients who received salvage chemotherapy (OR 6.81; p = 0.01) and those with a preoperative mass larger than 5cm (OR 7.24; p = 0.002). In addition, open conversion was associated with higher blood loss and transfusions, longer hospital stays, and more 90-day complications (Figure). Despite this, the 4-year RFS rates were comparable between these two groups.


Figure: Perioperative outcomes of patients with (red) and without (blue) open conversion during robotic PC-RPLND. EBL: estimated blood loss; LOS: length of hospital stays.

In conclusion, our study represents the largest series of robotic PC-RPLNDs reported to date. Our findings demonstrate acceptable intermediate-term oncological outcomes following this procedure in appropriately selected testicular cancer patients. Due to the complexity of the surgery, it should be performed at centers with expertise in testicular cancer and minimally invasive techniques.

Written by: Alireza Ghoreifi,1 Hooman Djaladat2


  1. SUO Fellow, Department of Urology, Duke University, Durham, NC, USA
  2. Professor of Urology, Department of Urology, University of Southern California, Los Angeles, CA, USA
References:

  1. Ghoreifi A, Mitra AP, McClintock G, Baky F, McDowell Z, Lavallée E, et al. Robotic post-chemotherapy retroperitoneal lymph node dissection for testicular cancer: A multicenter collaborative study. Urol Oncol. 2023; 41(2):111.e7-111.e14.
  2. Stephenson A, Bass EB, Bixler BR, Daneshmand S, Kirkby E, Marianes A, et al. Diagnosis and Treatment of Early-Stage Testicular Cancer: AUA Guideline Amendment 2023. J Urol. 2024;211(1):20-25.
  3. Ghoreifi A, Sheybaee Moghaddam F, Mitra AP, Khanna A, Singh A, Chavarriaga J, et al. Oncological Outcomes Following Robotic Postchemotherapy Retroperitoneal Lymph Node Dissection for Testicular Cancer: A Worldwide Multicenter Study. Eur Urol Focus. 2024: S2405-4569(24)00241-4.
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