Robot-assisted retroperitoneal lymph node dissection: Feasibility and outcome in postchemotherapy residual mass in testicular cancer

Abstract

Introduction:We aimed to evaluate the surgical feasibility, complication, and oncological outcome of robot-assisted retroperitoneal lymph node dissection (RA-RPLND) in patients of testicular tumor with postchemotherapy residual retroperitoneal mass.Methods:A total of 13 patients underwent RA-RPLND between January 2012 and September 2016 at our institute. A study was started on December 2015, so data were collected retrospectively and prospectively regarding patient demography, tumor characteristics, surgical, pathological outcome, and oncological outcome.Results:RA-RPLND was successfully completed in all the 13 patients. Lateral approach was used in initial 12 patients with unilateral dissection in 11 patients and bilateral dissection after in 1 patient after repositioning in bilateral position. Supine robotic approach used in 1 patient. Median operative time was 200 min, median estimated blood loss was 120 ml, and median length of hospital stay was 4 days. The median yield of lymph node was 20. Three patients had positive lymph nodes, all had teratoma germ cell tumor. Ten patients had only necrosis in lymph nodes. After median follow-up 23 months (range 3-58 months), no systemic or retroperitoneal recurrence was found. Four patients developed chyle leak. One patient was managed conservatively with diet modification, one with intranodal lipiodol lymphangiography and two patients were managed surgically.Conclusion:RA-RPLND is safe and feasible for postchemotherapy residual mass with accepted compilation rate, but larger studies are required to establish its diagnostic and therapeutic utility along with safety of the procedure.

Expanding the indications of robotic surgery in urology: A systematic review of the literature

“…In the largest series of 47 patients (all chemotherapy naïve), Pearce et al [89] performed R-RPLND in 42 patients with clinical Stage I disease. Although R-RPLND in post-chemotherapy patients has been described, this is only in 37 of the 126 reported cases [86] , [87] , [88] , [89] , [90] , [91] . The preference to perform R-RPLND in chemo-naïve clinical Stage I patients is not consistent with contemporary practice [93] .…”

“…Two of these case series were in less than three patients. Data summarised from the remaining six larger case series are presented in Table 6 [86] , [87] , [88] , [89] , [90] , [91] .…”

What's inside

“…Retroperitoneal lymph node dissection is recommended for residual masses after chemotherapy for nonseminomatous germ cell tumors since germ cell tumor elements may persist in about 50% of patients. Singh and co-workers[ 2 ] report their experience with robotic retroperitoneal lymphadenectomy in a series of 13 such men. They report a median yield of 20 lymph nodes.…”

Novel strategies of Raman imaging for monitoring intracellular retinoid metabolism in cancer cells

“…During the past decade, many studies have suggested that the metabolic fate of pyruvate is regulated by tyrosine phosphorylation. [35] Vitamin A plays an important role in cell signaling. Abnormal retinoid signaling in the cytoplasm and nucleus has been reported in human cancers.…”