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

Abstract

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.

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

“…After 41 months of follow-up, only one patient experienced recurrence. Recent studies also seem to support lower recurrence rates in RA-RPLND 12 , 41 . However, the current studies have had short follow-up times, and further studies are needed to confirm the long-term oncological outcomes of RA-RPLND.…”

Lymph Node Dissection in Testicular Cancer: The State of the Art and Future Perspectives

“…An analysis of 20-year-long data from patients who underwent P-RPLND or PC-RPLND showed overall survival (OS) rate of 89%, cancer-specific survival (CSS) rate of 92%, and recurrence-free survival (RFS) of 85%. During a 120-month follow-up, 15% of these patients experienced recurrence [ 84 ]. In another study, during a 33-month follow-up, 9% of patients experienced relapse after lRPLND or rRPLND [ 85 ••].…”

Testicular Cancer Treatments and Sexuality: A Narrative Review

“…Thus, the rationale for RPLND in TC patients is related to the following: (1) the retroperitoneum is the most common site of metastasis; (2) 15% to 25% incidence of retroperitoneal teratoma (which is chemo-resistant) in those with occult metastasis is found in the retroperitoneum [85][86][87]; (3) RPLND may lead to low risk of abdominopelvic recurrence [84,88]; (4) avoidance of chemotherapy in more than 75% or more of patients if adjuvant chemotherapy is restricted to those with extensive retroperitoneal malignancy (pN2-3) [89][90][91][92]. The disadvantages of RPLND are that all patients undergo major abdominal surgery, it requires the availability of experienced surgeons and thus may not be deliverable to all patients, and it is associated with the highest rate of double therapy [93,94]. Roughly, 25% of non-seminoma patients undergo RPLND during the therapeutic pathway [95][96][97][98].…”