Clinical outcome of robot-assisted residual mass resection in metastatic nonseminomatous germ cell tumor

Abstract

Purpose To evaluate the outcome of robot-assisted residual mass resection (RA-RMR) in nonseminomatous germ cell tumor (NSGCT) patients with residual tumor following chemotherapy. Patients and methods Retrospective medical chart analysis of all patients with NSGCT undergoing RA-RMR at two tertiary referral centers between January 2007 and April 2019. Patients were considered for RA-RMR in case of a residual tumor between 10 and 50 mm at cross-sectional computed tomography (CT) imaging located ventrally or laterally from the aorta or vena cava, with normalized tumor markers following completion of chemotherapy, and no history of retroperitoneal surgery. Results A total of 45 patients were included in the analysis. The Royal Marsden stage before chemotherapy was IIA in 13 (28.9%), IIB in 16 (35.6%), IIC in 3 (6.7%) and IV in 13 patients (28.9%). The median residual tumor size was 1.9 cm (interquartile range [IQR] 1.4–2.8; range 1.0–5.0). Five procedures (11.1%) were converted to an open procedure due to a vascular injury (n = 2), technical difficulty (n = 2) or tumor debris leakage (n = 1). A postoperative adverse event occurred in two patients (4.4%). Histopathology showed teratoma, necrosis and viable cancer in 29 (64.4%), 14 (31.1%), and two patients (4.4%), respectively. After a median follow-up of 41 months (IQR 22–70), one patient (2.2%) relapsed in the retroperitoneum. The one- and 2-year recurrence-free survival rate was 98%. Conclusion RA-RMR is an appropriate treatment option in selected patients, potentially providing excellent cure rates with minimal morbidity. Long-term outcome data are needed to further support this strategy and determine inclusion and exclusion criteria.

Indications, feasibility and outcome of robotic retroperitoneal lymph node dissection for metastatic testicular germ cell tumours

“…Thus, especially at the implementation of the technique, one has to bear a higher complication rate in mind, and starting in patients with limited disease seems reasonable. In summary our results are in line with the results of other large volume series on R-RPLND 22 , 27 , 28 .…”

“…To date, most of the studies on R-RPLND have reported on pR-RPLND 10 , 18 , 22 – 25 , with the largest cohort comprising 58 patients including mainly CS 1 tumours 22 . Only a few publications on pcR-RPLND are available 11 , 12 , 26 , 27 , with the largest series comprising 45 patients 27 . So far, only one other publication exists on R-RPLND in a mere mTGCT patient collective, comprising both pR-RPLND (n = 22) and pcR-RPLND (n = 4) patients 28 .…”

Robot‐assisted retroperitoneal lymph node dissection: a systematic review of perioperative outcomes

“…A total of 37 studies [7,21–56] were included. Of these, 12 studies [7,21,23–25,28–32,34,35] described patients who underwent primary R‐RPLND only, 16 [38–53] described patients who underwent post‐chemotherapy R‐RPLND only, and six [22,26,27,33,36,37] included patients who underwent R‐RPLND in either of these settings.…”

“…A total of 37 studies [7,21–56] were included. Of these, 12 studies [7,21,23–25,28–32,34,35] described patients who underwent primary R‐RPLND only, 16 [38–53] described patients who underwent post‐chemotherapy R‐RPLND only, and six [22,26,27,33,36,37] included patients who underwent R‐RPLND in either of these settings. Two studies involving post‐chemotherapy RPLND were published from the same centre at two different time periods [39,41]; hence, the series published on a later date was included in the cumulative analysis [41].…”

“…3B). Currently, the platform most used for R-RPLND is the da Vinci â Xi, and most contemporary series report the outcomes of R-RPLND in either the supine [32,34,36,50,53] or flank [33][34][35]52] position. However, there has been no direct comparison of outcomes between the supine and flank approaches, and the choice of patient positioning remains at the surgeon's discretion.…”