Outcomes of Postchemotherapy Retroperitoneal Lymph Node Dissection from a High-volume UK Centre Compared with a National Data Set

Pearce, Adam; Manson-Bahr, David; Reid, Allen F.; Huddart, Robert; Mayer, Erik; Nicol, David

doi:10.1016/j.euros.2021.09.005

Cited by 15 publications

(8 citation statements)

References 16 publications

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“…Across the PC-R-RPLND series, peri-operative outcomes such as blood loss and LOS remained in line with primary R-RPLND and improved over PC-O-RPLND. Although overall complications were more prevalent after chemotherapy, this is similar in the open experience [33,38,39]. Importantly, early recurrence was minimal and analogous to O-RPLND in a comparative series.…”

Section: Postchemotherapy Robot-assisted Retroperitoneal Lymph Node D...supporting

confidence: 69%

Robotic-assisted retroperitoneal lymph node dissection for testicular cancer

Gereta

Hung

2023

Current Opinion in Urology

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Purpose of reviewRobotic-assisted retroperitoneal lymph node dissection (R-RPLND) is an emerging surgical option for testicular cancer with less morbidity than open RPLND. We outline the operative technique used at our center and review contemporary evidence in the advancement of R-RPLND.Recent findings R-RPLND is being applied effectively beyond clinical stage I testicular cancer to treat low-volume, clinical stage II disease in both the primary and postchemotherapy setting. Compared with the open approach, R-RPLND offers shorter hospitalization and less blood loss with comparably low complications and oncologic control.

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Section: Postchemotherapy Robot-assisted Retroperitoneal Lymph Node D...supporting

confidence: 69%

Robotic-assisted retroperitoneal lymph node dissection for testicular cancer

Gereta

Hung

2023

Current Opinion in Urology

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“…An important concern when performing RPLND is the completeness of dissection. The lymph node count is often used as a surrogate for good RPLND [69,70]. In a study analysing 255 patients undergoing primary RPLND using the Memorial Sloan-Kettering Testis Cancer Database, lymph node counts >40 were associated with a positive finding on pathology and the quality of surgery [71].…”

Section: Discussionmentioning

confidence: 99%

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

Garg¹,

Mansour²,

Psutka

et al. 2023

BJU International

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To assess the safety and feasibility of robot-assisted retroperitoneal lymph node dissection (R-RPLND) and to compare the perioperative outcomes of R-RPLND with open RPLND (O-RPLND), as RPLND forms an integral part of the management of testis cancer and R-RPLND is a minimally invasive treatment option for this disease. Materials and MethodsThe PubMed â , Scopus â , Cochrane Central Register of Controlled Trials, and Web of Science TM databases were searched for studies reporting perioperative outcomes of primary and post-chemotherapy R-RPLND and studies comparing R-RPLND with O-RPLND. ResultsThe search yielded 42 articles describing R-RPLND, including five comparative studies. The systematic review included 4222 patients (single-arm studies, n = 459; comparative studies, n = 3763). Of 459 patients in the single-arm studies, 271 underwent primary R-RPLND and 188 underwent post-chemotherapy R-RPLND. For primary R-RPLND, the operative time ranged from 175 to 540 min and the major complication rate was 4.1%. For post-chemotherapy R-RPLND, the operative time ranged from 134 to 550 min and the major complication rate was 8.5%. The conversion rate to open surgery was 2.2% in primary R-RPLND and 9.0% in post-chemotherapy R-RPLND. In comparison with O-RPLND, R-RPLND was associated with a lower transfusion rate (14.5% vs 0.9%, P < 0.001) and a lower complication rate (18.5% vs 7.8%, P = 0.002). ConclusionRobot-assisted RPLND has acceptable perioperative outcomes in both the primary and post-chemotherapy settings but a notable rate of conversion to open surgery in the post-chemotherapy setting. Compared with O-RPLND, R-RPLND is associated with a lower transfusion rate and fewer overall complications. Given the potential impact of selection bias, the optimal patient selection criteria for R-RPLND remain to be elucidated.

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“…Many studies have focused on the role of the center surgical volume and the surgeon’s experience [ 14 , 15 , 16 ]. Complication rates directly correlate with surgeon volume and experience; therefore, NICE and the European Consensus Conference on Diagnosis and Treatment of Germ Cell Cancer recommended performing RPLND only in specialized centers, regardless of the surgical approach [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Twenty Years’ Experience in Retroperitoneal Lymph Node Dissection for Testicular Cancer in a Tertiary Referral Center

et al. 2023

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Background and Objectives: The aim of this article is to present a single-surgeon, open retroperitoneal lymph node dissection (RPLND) series for testicular cancer in a high-volume center. Materials and Methods: We reviewed data from patients who underwent RPLND performed by an experienced surgeon at our institution between 2000 and 2019. We evaluated surgical and perioperative outcomes, complications, Recurrence-Free Survival (RFS), Overall Survival (OS), and Cancer-Specific Survival (CSS). Results: RPLND was performed in primary and secondary settings in 21 (32%) and 44 (68%) patients, respectively. Median operative time was 180 min. Median hospital stay was 6 days. Complications occurred in 23 (35%) patients, with 9 (14%) events reported as Clavien grade ≥ 3. Patients in the primary RPLND group were significantly younger, more likely to have NSGCT, had higher clinical N0 and M0, and had higher nerve-sparing RPLND (all p ≤ 0.04) compared to those in the secondary RPLND group. In the median follow-up of 120 (56–180) months, 10 (15%) patients experienced recurrence. Finally, 20-year OS, CSS, and RFS were 89%, 92%, and 85%, respectively, with no significant difference in survival rates between primary vs. secondary RPLND subgroups (p = 0.64, p = 0.7, and p = 0.31, respectively). Conclusions: Open RPLND performed by an experienced high-volume surgeon achieves excellent oncological and functional outcomes supporting the centralization of these complex procedures.

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Outcomes of Postchemotherapy Retroperitoneal Lymph Node Dissection from a High-volume UK Centre Compared with a National Data Set

Cited by 15 publications

References 16 publications

Robotic-assisted retroperitoneal lymph node dissection for testicular cancer

Robotic-assisted retroperitoneal lymph node dissection for testicular cancer

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

Twenty Years’ Experience in Retroperitoneal Lymph Node Dissection for Testicular Cancer in a Tertiary Referral Center

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