Robotic retroperitoneal lymph node dissection for testicular cancer at a national referral centre

Abstract

Objectives We aim to determine if robot‐assisted retroperitoneal lymph node dissection (R‐RPLND) can be performed as a safe option to open RPLND in selected patients with metastatic germ cell cancer. Patients and methods This population‐based prospective study was performed at a one of two national referral centres for RPLND in Sweden. All patients referred during January 2017–March 2021 were screened for possible inclusion. R‐RPLND was performed using the Da Vinci Xi surgical system. Perioperative parameters, postoperative complications (Clavien–Dindo), final pathology, preservation of antegrade ejaculation and relapse rates were evaluated. Classifiers for selecting patients to open versus robotic RPLND were analysed by logistic regression modelling. The median follow‐up was 23 months. Results Of 87 patients referred, 29 were selected for R‐RPLND, 19 in a post‐chemotherapy setting. In median, retroperitoneal tumour diameter was 18 mm, BMI 24 kg/m2, operative time 433 min, estimated blood loss 50 ml and length of stay 3 days. One patient underwent open conversion due to failure to progress. Four patients had Clavien–Dindo grade 3 complications, of which three were chylous‐related. No in‐field recurrences occurred during follow‐up. Conclusion This population‐based study suggests that R‐RPLND can be safely performed in at least one third of patients referred for an RPLND. A relatively high rate of lymph‐leakage may represent a potential drawback. Tumour size may be the most important discriminator when deciding on robotic versus open RPLND. Further studies with longer follow‐up are needed to validate the results.

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

“…2A). Li et al [58] and Grenabo Bergdahl et al [61] reported similar operative times for the two approaches (Table 6). The remaining study by Lloyd et al [60] reported that the operative time was shorter for R-RPLND than for O-RPLND (150 vs 240 min, P < 0.001).…”

“…Five studies [57][58][59][60][61] comprising 3763 patients compared outcomes between those who underwent R-RPLND (n = 400) and those who underwent O-RPLND (n = 3363). Four of these studies [57][58][59][60] were performed retrospectively and one [61] had a prospective non-randomised design.…”

“…Five studies [57][58][59][60][61] comprising 3763 patients compared outcomes between those who underwent R-RPLND (n = 400) and those who underwent O-RPLND (n = 3363). Four of these studies [57][58][59][60] were performed retrospectively and one [61] had a prospective non-randomised design. Two studies analysed multi-institutional data from the Paediatric Health Information System [57] and the Nationwide Inpatient Sample [59] databases.…”

Red Out: Bleeding During Robotic Retroperitoneal Lymph Node Dissection and Strategies To Manage It

“…Vascular injury can occur during bowel mobilisation when gaining exposure to the great vessels. One group described an inferior mesenteric artery injury during rRPLND that was repaired robotically [13] .…”

Shining a little light on peer review debates

“…Grenabo Bergdahl et al 7 provide a series of ‘beyond feasibility’ data for post chemotherapy testis cancer selected for robotic resection. From two Swedish centres they had 87 cases over a four‐year period and median 23‐month follow‐up.…”