To describe and compare differences in peri-operative outcomes of robot-assisted (RA-RPLND) and open (O-RPLND) retroperitoneal lymph node dissection performed by a single surgeon where chemotherapy is the standard initial treatment for Stage 2 or greater non-seminomatous germ cell tumour.
Review of a prospective database of all RA-RPLNDs (28 patients) and O-RPLNDs (72 patients) performed by a single surgeon from 2014 to 2020. Peri-operative outcomes were compared for patients having RA-RPLND to all O-RPLNDs and a matched cohort of patients having O-RPLND (20 patients). Further comparison was performed between all patients in the RA-RPLND group (21 patients) and matched O-RPLND group (18 patients) who had previous chemotherapy. RA-RPLND was performed for patients suitable for a unilateral template dissection. O-RPLND was performed prior to the introduction of RA-RPLND and for patients not suitable for RA-RPLND after its introduction.
RA-RPLND showed improved peri-operative outcomes compared to the matched cohort of O-RPLND-median blood loss (50 versus 400 ml, p < 0.00001), operative duration (150 versus 195 min, p = 0.023) length-of-stay (1 versus 5 days, p < 0.00001) and anejaculation (0 versus 4, p = 0.0249). There was no statistical difference in complication rates. RA-RPLND had lower median lymph node yields although not significant (9 versus 13, p = 0.070). These improved peri-operative outcomes were also seen in the post-chemotherapy RA-RPLND versus O-RPLND analysis. There were no tumour recurrences seen in either group with median follow-up of 36 months and 60 months, respectively.
Post-chemotherapy RA-RPLND may have decreased blood loss, operative duration, hospital length-of-stay and anejaculation rates in selected cases and should, therefore, be considered in selected patients. Differences in oncological outcomes require longer term follow-up.
World journal of urology. 2021 Oct 01 [Epub ahead of print]
Paul Lloyd, Anne Hong, Marc A Furrer, Elaine W Y Lee, Harveer S Dev, Maurice H Coret, James M Adshead, Peter Baldwin, Richard Knight, Jonathan Shamash, Constantine Alifrangis, Sara Stoneham, Danish Mazhar, Han Wong, Anne Warren, Ben Tran, Nathan Lawrentschuk, David E Neal, Benjamin C Thomas
Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK., Department of Urology, Royal Melbourne Hospital, Melbourne, Australia., Department of Urology, Lister Hospital, Stevenage, UK., Department of Gynae-Oncology, Addenbrooke's Hospital, Cambridge, UK., Department of Oncology, St Bartholomew's Hospital, London, UK., Department of Oncology, University College London Hospital, London, UK., Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK., Department of Pathology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK., Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia., Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK. .