To evaluate the feasibility, safety, and early oncologic outcomes after post-chemotherapy robot-assisted retroperitoneal lymph node dissection (PC-RARPLND) for metastatic germ cell tumors (mGCT).
We retrospectively analyzed patients from four tertiary centers who underwent PC-RARPLND for mGCT, from 2011 to 2021. Previous treatment of mGCT, intraoperative and postoperative complications, and early oncologic outcomes were assessed.
Overall, 66 patients were included. The majority of patients had non-seminoma mTGCT (89%). Median size of retroperitoneal lymph node (RLN) before surgery was 26 mm. Templates of PC-RARPLND were left modified, right modified, and full bilateral in 56%, 27%, and 14%, respectively. Median estimated blood loss and length of stay were 50 mL [50-150] and 2 [1-3] days. Four patients (6.1%) had a vascular injury, only one with significant blood loss and conversion to open surgery (OS). Two other patients had a conversion to OS for difficulty of dissection. No patient had transfusion, most frequent complications were ileus (10.6%) and symptomatic lymphorrea (7.6%) and no complications grade IIIb or more occurred. With a median follow-up of 16 months, two patients had a relapse, all outside of the surgical template (one in the retrocrural space with reascending markers, one in lungs).
PC-RARPLND is a challenging surgery. In expert centers and for selected patients, it seemed safe and feasible, with a low morbidity. Further prospective evaluation of this procedure and long-term oncologic results are needed.
World journal of urology. 2023 Jul 28 [Epub ahead of print]
Nicolas Branger, Franck Bladou, Gregory Verhoest, Sophie Knipper, Grégoire Robert, Jean-Christophe Bernhard, Jean-Baptiste Beauval, Abderrahmane Khaddad, Anne Mauger De Varennes, Aude Fléchon, Jochen Walz, Anne-Sophie Bageot, Nicolas Doumerc, Morgan Rouprêt, Thibault Murez, French AFU Testicular Cancer Committee
Department of Urology, Institut Paoli Calmettes Cancer Center, Marseille, France. ., Department of Urology, CHU Bordeaux, Bordeaux, France., Department of Urology, CHU Rennes, Rennes, France., Department of Urology, Institut Paoli Calmettes Cancer Center, Marseille, France., Department of Urology, CHU Toulouse, Toulouse, France., Department of Oncology, Centre Léon Bérard, Lyon, France., Department of Urology, La Pitié Salpêtrière, Paris, France., Department of Urology, CHU Montpellier, Montpellier, France.