The role of robotic retroperitoneal lymph node dissection in testicular cancer: a systematic review and meta-analysis

Abstract

Objective: To compare the safety and efficacy of robotic-assisted retroperitoneal lymph node dissection (RA-RPLND) versus non-robotic retroperitoneal lymph node dissection in testicular cancer. Methods: The statistical analysis software used Stata 17. The weighted mean difference (WMD) represents the continuous variable, and the dichotomous variable chooses the odds ratio, and calculates the 95% CI. This systematic review and cumulative meta-analysis was performed according to PRISMA criteria, and AMSTAR guidelines (assessing the methodological quality of systematic reviews). The Embase, PubMed, Cochrane Library, Web of Science, and Scopus databases were searched. The upper limit of the search time frame was February 2023, and no lower limit was set. Results: Seven studies involving 862 patients. Compared with open retroperitoneal lymph node dissection, RA-RPLND appears to have a shorter length of stay [WMD=−1.21, 95% CI (−1.66, −0.76), P<0.05], less estimated blood loss [WMD=−0.69, 95% CI (−1.07, −0.32), P<0.05], and lower overall complications [odds ratio=0.45, 95% CI (0.28, 0.73), P<0.05]. RA-RPLND appears to have more lymph node yields than laparoscopic retroperitoneal lymph node dissection [WMD=5.73, 95% CI (1.06, 10.40), P<0.05]. However, robotic versus open/laparoscopic retroperitoneal lymph node dissection had similar results in operation time, lymph node positivity rate, recurrence during follow-up, and postoperative ejaculation disorders. Conclusion: RA-RPLND appears to be safe and effective for testicular cancer, but longer follow-up and more studies are needed to confirm this.

Robotic-assisted retroperitoneal lymph node dissection for testicular cancer: benefit and limitation

“…That meta-analysis 1 found that patients undergoing robotic-assisted RPLND had a significantly shorter length of hospital stay compared to those receiving open RPLND, with a mean difference of −1.21 days (95% CI −1.66, −0.76). This indicates that, on average, the use of the robotic surgical approach reduced hospitalization by more than 1 day.…”

“…The availability of robot-assisted RPLND could meaningfully impact the length of stay metrics for institutions that perform a high volume of RPLND for testicular cancer. Despite this encouraging finding, there was significant heterogeneity among the included studies ( I 2 =78.9%) 1 . This indicates variability in the effect sizes, somewhat conflicting results, and potential influencing factors that were not accounted for.…”

“… 1 , titled ‘The role of robotic retroperitoneal lymph node dissection in testicular cancer: a systematic review and meta-analysis,’ caught our attention for its thorough evaluation of robot-assisted versus open and laparoscopic retroperitoneal lymph node dissection (RPLND) in the treatment of testicular cancer. The authors reported that, compared to open RPLND, robot-assisted RPLND was associated with significantly shorter hospital stays, less blood loss, and fewer overall complications without differences in operative time, nodal yields, or recurrence rates 1 . When compared to laparoscopic RPLND, robotic-assisted RPLND had higher nodal yields but no other outcome differences 1 .…”

“…The authors reported that, compared to open RPLND, robot-assisted RPLND was associated with significantly shorter hospital stays, less blood loss, and fewer overall complications without differences in operative time, nodal yields, or recurrence rates 1 . When compared to laparoscopic RPLND, robotic-assisted RPLND had higher nodal yields but no other outcome differences 1 . Given the excellent prognosis of testicular cancer when managed correctly and the increasing adoption of minimally invasive surgeries for complex RPLND procedures, the study by Ge et al .…”

“…Given the excellent prognosis of testicular cancer when managed correctly and the increasing adoption of minimally invasive surgeries for complex RPLND procedures, the study by Ge et al . 1 is highly relevant and timely.…”