The role of retroperitoneal lymph node dissection (RPLND) in testicular cancer is well established in both the primary and post-chemotherapy setting. The aim of this study was to report our 2 years oncological outcomes of robotic RPLND. A retrospective review was performed of all patients undergoing robotic RPLND by a single surgeon at Princess Margaret Cancer Centre. Demographic, perioperative, and oncologic data were analyzed using descriptive statistics. Between September 2014 and June 2020, 141 patients underwent an RPLND [33 (23.4%) were primary, 108 (76.6%) were post-chemotherapy]. 27 (19.1%) patients underwent a robotic bilateral template nerve-sparing RPLND. RPLND indication was primary (i.e. pre-chemotherapy) in 18 (66.7%), and post-chemotherapy in 9 (33.3%) patients. Stage at RPLND was 2A (n = 15, 55.6%), 2B (n = 9, 33.3%), 2C (n = 1, 3.7%) and 3 (n = 2, 7.4%). Median OR time (incision to closure) was 525 min and blood loss was 200 ml. Nerve sparing was performed in all but one case. Six (22.2%) adjuvant procedures were performed including two (7.4%) vascular repairs. Median length of stay was 2 days. Viable tumor was detected in 17 (63%) and teratoma in 9 (33.3%). Median follow-up was 31.3 months. No adjuvant chemotherapy was given. Three patients (11.1%) relapsed: 2 out-of-field and 1 with both in-field and out-of-field disease. Robotic RPLND can be performed safely. Long-term follow-up of series such as ours, enriched with patients with viable disease and/or teratoma, and not treated with adjuvant chemotherapy is required to ensure oncological outcomes are comparable to the open approach.
Journal of robotic surgery. 2021 May 12 [Epub ahead of print]
G J Nason, K Kuhathaas, L Anson-Cartwright, M A S Jewett, M O'Malley, J Sweet, A Hansen, P Bedard, P Chung, E Hahn, P Warde, R J Hamilton
Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, 610 University Avenue, Suite 3-130, Toronto, ON, M5G 1X5, Canada., Division of Abdominal Imaging, Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada., Department of Pathology and Lab Medicine, University Health Network, University of Toronto, Toronto, ON, Canada., Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada., Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada., Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, 610 University Avenue, Suite 3-130, Toronto, ON, M5G 1X5, Canada. .