Robot-assisted Retroperitoneal Lymph Node Dissection: Feasibility and Outcome in Postchemotherapy Residual Mass in Testicular Cancer

Overview

Journal Indian J Urol

Specialty Urology

Date 2017 Oct 13

PMID 29021655

Citations 20

Authors

Amitabh Singh

Smaranjit Chatterjee

Prashant Bansal

Abhishek Bansal

Sudhir Rawal

Affiliations

Soon will be listed here.

Abstract

Introduction: We aimed to evaluate the surgical feasibility, complication, and oncological outcome of robot-assisted retroperitoneal lymph node dissection (RA-RPLND) in patients of testicular tumor with postchemotherapy residual retroperitoneal mass.

Methods: A total of 13 patients underwent RA-RPLND between January 2012 and September 2016 at our institute. A study was started on December 2015, so data were collected retrospectively and prospectively regarding patient demography, tumor characteristics, surgical, pathological outcome, and oncological outcome.

Results: RA-RPLND was successfully completed in all the 13 patients. Lateral approach was used in initial 12 patients with unilateral dissection in 11 patients and bilateral dissection after in 1 patient after repositioning in bilateral position. Supine robotic approach used in 1 patient. Median operative time was 200 min, median estimated blood loss was 120 ml, and median length of hospital stay was 4 days. The median yield of lymph node was 20. Three patients had positive lymph nodes, all had teratoma germ cell tumor. Ten patients had only necrosis in lymph nodes. After median follow-up 23 months (range 3-58 months), no systemic or retroperitoneal recurrence was found. Four patients developed chyle leak. One patient was managed conservatively with diet modification, one with intranodal lipiodol lymphangiography and two patients were managed surgically.

Conclusion: RA-RPLND is safe and feasible for postchemotherapy residual mass with accepted compilation rate, but larger studies are required to establish its diagnostic and therapeutic utility along with safety of the procedure.

Citing Articles

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

Malkiewicz B, Swirkosz G, Lewandowski W, Demska K, Szczepaniak Z, Karwacki J Curr Oncol Rep. 2024; 26(4):318-335.

PMID: 38430323 PMC: 11021343. DOI: 10.1007/s11912-024-01511-y.

Lipiodol embolization for chylous leak complication post robotic-assisted para-aortic lymph node resection.

Shamsuddin Perisamy R, Rusli R, Kamis M, Tharek A, Soo T Radiol Case Rep. 2024; 19(3):906-909.

PMID: 38188955 PMC: 10770492. DOI: 10.1016/j.radcr.2023.11.074.

Red Out: Bleeding During Robotic Retroperitoneal Lymph Node Dissection and Strategies To Manage It.

Reeves F, George N, Challacombe B Eur Urol Open Sci. 2023; 48:84-89.

PMID: 36636308 PMC: 9829689. DOI: 10.1016/j.euros.2022.09.003.

Robot-assisted retroperitoneal lymph node dissection for post-chemotherapy residual mass in testicular cancer: Long-term experience from a tertiary care centre.

Vasudeo V, Khanna A, Pratihar S, Jaipuria J, Chakraborty A, Rawal S J Minim Access Surg. 2023; 19(2):288-295.

PMID: 36629220 PMC: 10246628. DOI: 10.4103/jmas.jmas_141_22.

Robotic retroperitoneal lymph node dissection for testicular cancer at a national referral centre.

Bergdahl A, Mansson M, Holmberg G, Fovaeus M BJUI Compass. 2022; 3(5):363-370.

PMID: 35950045 PMC: 9349583. DOI: 10.1002/bco2.149.

References

Patel M, Porter J . Robotic retroperitoneal partial nephrectomy. World J Urol. 2013; 31(6):1377-82. DOI: 10.1007/s00345-013-1038-y. View

Abaza R . Robotic surgery and minimally invasive management of renal tumors with vena caval extension. Curr Opin Urol. 2011; 21(2):104-9. DOI: 10.1097/MOU.0b013e32834350ff. View

Schwartz M, Kavoussi L . Controversial technology: the Chunnel and the laparoscopic retroperitoneal lymph node dissection (RPLND). BJU Int. 2010; 106(7):950-9. DOI: 10.1111/j.1464-410X.2010.09659.x. View

Beck S, Foster R, Bihrle R, Donohue J, Einhorn L . Is full bilateral retroperitoneal lymph node dissection always necessary for postchemotherapy residual tumor?. Cancer. 2007; 110(6):1235-40. DOI: 10.1002/cncr.22898. View

Steyerberg E, Keizer H, Fossa S, Sleijfer D, Toner G, Schraffordt Koops H . Prediction of residual retroperitoneal mass histology after chemotherapy for metastatic nonseminomatous germ cell tumor: multivariate analysis of individual patient data from six study groups. J Clin Oncol. 1995; 13(5):1177-87. DOI: 10.1200/JCO.1995.13.5.1177. View

Cost N, Dajusta D, Granberg C, Cooksey R, Laborde C, Wickiser J . Robot-assisted laparoscopic retroperitoneal lymph node dissection in an adolescent population. J Endourol. 2011; 26(6):635-40. DOI: 10.1089/end.2011.0214. View

Carver B, Shayegan B, Eggener S, Stasi J, Motzer R, Bosl G . Incidence of metastatic nonseminomatous germ cell tumor outside the boundaries of a modified postchemotherapy retroperitoneal lymph node dissection. J Clin Oncol. 2007; 25(28):4365-9. DOI: 10.1200/JCO.2007.11.2078. View

Williams S, Lau C, Josephson D . Initial series of robot-assisted laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell testicular cancer. Eur Urol. 2011; 60(6):1299-302. DOI: 10.1016/j.eururo.2011.03.009. View

Gerber G, Bissada N, Hulbert J, Kavoussi L, Moore R, Kantoff P . Laparoscopic retroperitoneal lymphadenectomy: multi-institutional analysis. J Urol. 1994; 152(4):1188-91; discussion 1191-2. DOI: 10.1016/s0022-5347(17)32536-3. View

10.

Evans J, Spiess P, Kamat A, Wood C, Hernandez M, Pettaway C . Chylous ascites after post-chemotherapy retroperitoneal lymph node dissection: review of the M. D. Anderson experience. J Urol. 2006; 176(4 Pt 1):1463-7. DOI: 10.1016/j.juro.2006.06.016. View

11.

Davol P, Sumfest J, Rukstalis D . Robotic-assisted laparoscopic retroperitoneal lymph node dissection. Urology. 2006; 67(1):199. DOI: 10.1016/j.urology.2005.07.022. View

12.

Rukstalis D, Chodak G . Laparoscopic retroperitoneal lymph node dissection in a patient with stage 1 testicular carcinoma. J Urol. 1992; 148(6):1907-9; discussion 1909-10. DOI: 10.1016/s0022-5347(17)37068-4. View

13.

Castillo O, Litvak J, Kerkebe M, Olivares R, Urena R . Case report: laparoscopic management of massive chylous ascites after salvage laparoscopic retroperitoneal lymph-node dissection. J Endourol. 2006; 20(6):394-6. DOI: 10.1089/end.2006.20.394. View

14.

Dogra P, Singh P, Saini A, Regmi K, Singh B, Nayak B . Robot assisted laparoscopic retroperitoneal lymph node dissection in testicular tumor. Urol Ann. 2013; 5(4):223-6. PMC: 3835975. DOI: 10.4103/0974-7796.120289. View

15.

Rogers C, Singh A, Blatt A, Linehan W, Pinto P . Robotic partial nephrectomy for complex renal tumors: surgical technique. Eur Urol. 2007; 53(3):514-21. PMC: 2644902. DOI: 10.1016/j.eururo.2007.09.047. View

16.

Stepanian S, Patel M, Porter J . Robot-assisted Laparoscopic Retroperitoneal Lymph Node Dissection for Testicular Cancer: Evolution of the Technique. Eur Urol. 2016; 70(4):661-667. DOI: 10.1016/j.eururo.2016.03.031. View

17.

Heidenreich A, Pfister D, Witthuhn R, Thuer D, Albers P . Postchemotherapy retroperitoneal lymph node dissection in advanced testicular cancer: radical or modified template resection. Eur Urol. 2008; 55(1):217-24. DOI: 10.1016/j.eururo.2008.09.027. View

18.

Neyer M, Peschel R, Akkad T, Springer-Stohr B, Berger A, Bartsch G . Long-term results of laparoscopic retroperitoneal lymph-node dissection for clinical stage I nonseminomatous germ-cell testicular cancer. J Endourol. 2007; 21(2):180-3. DOI: 10.1089/end.2006.0233. View

19.

Link R, Amin N, Kavoussi L . Chylous ascites following retroperitoneal lymphadenectomy for testes cancer. Nat Clin Pract Urol. 2006; 3(4):226-32. DOI: 10.1038/ncpuro0457. View

20.

Steiner H, Leonhartsberger N, Stoehr B, Peschel R, Pichler R . Postchemotherapy laparoscopic retroperitoneal lymph node dissection for low-volume, stage II, nonseminomatous germ cell tumor: first 100 patients. Eur Urol. 2012; 63(6):1013-7. DOI: 10.1016/j.eururo.2012.09.036. View