Comparison of Laparoscopic, Robotic, and Open Retroperitoneal Lymph Node Dissection for Non-seminomatous Germ Cell Tumor: a Single-center Retrospective Cohort Study

Overview

Journal World J Urol

Specialty Urology

Date 2023 Jun 18

PMID 37332060

Authors

Juntao Lin

Zhenghui Hu

Shihan Huang

Bohua Shen

Shuo Wang

Jianjun Yu

Ping Wang

Xiaodong Jin

Affiliations

Soon will be listed here.

Abstract

Purpose: To compare the perioperative outcomes of L-RPLND, R-RPLND and O-RPLND, and determine which one can be the mainstream option.

Methods: We retrospectively reviewed medical records of 47 patients undergoing primary RPLND by three different surgical techniques for stage I-II NSGCT between July 2011 and April 2022 at our center. Standard open and laparoscopic RPLND was performed with usual equipment, and robotic RPLND was operated with da Vinci Si system.

Results: Forty-seven patients underwent RPLND during 2011-2022, and 26 (55.3%) of them received L-RPLND, 14 (29.8%) were operated with robot, while 7 (14.9%) were performed O-RPLND. The median follow-up was 48.0 months, 48.0 months, and 60.0 months, respectively. The oncological outcomes were comparable among all groups. In L-RPLND group, there were 8 (30.8%) cases of low grade (Clavien I-II) complications, and 3 (11.5%) cases of high-grade (Clavien III-IV) complications. In R-RPLND group, one (7.1%) low-grade complication and four (28.6%) high-grade complications were observed. In O-RPLND group, there were 2 (28.5%) cases of low-grade complications and one case (14.2%) of high-grade one. The operation duration of L-RPLND was the shortest. In O-RPLND group, the number of positive lymph nodes were higher than other two groups. Patients undergoing open surgery had lower (p < 0.05) red blood cell count, hemoglobin level, and higher (p < 0.05) estimated blood loss, white blood cell count than those receiving either laparoscopic or robotic surgery.

Conclusion: All three surgical techniques are comparable in safety, oncological, andrological, and reproductive outcomes under the circumstance of not using primary chemotherapy. L-RPLND might be the most cost-effective option.

References

Pishgar F, Haj-Mirzaian A, Ebrahimi H, Moghaddam S, Mohajer B, Nowroozi M . Global, regional and national burden of testicular cancer, 1990-2016: results from the Global Burden of Disease Study 2016. BJU Int. 2019; 124(3):386-394. DOI: 10.1111/bju.14771. View

Stephenson A, Eggener S, Bass E, Chelnick D, Daneshmand S, Feldman D . Diagnosis and Treatment of Early Stage Testicular Cancer: AUA Guideline. J Urol. 2019; 202(2):272-281. DOI: 10.1097/JU.0000000000000318. View

Albers P, Albrecht W, Algaba F, Bokemeyer C, Cohn-Cedermark G, Fizazi K . Guidelines on Testicular Cancer: 2015 Update. Eur Urol. 2015; 68(6):1054-68. DOI: 10.1016/j.eururo.2015.07.044. View

Fung C, Sesso H, Williams A, Kerns S, Monahan P, Zaid M . Multi-Institutional Assessment of Adverse Health Outcomes Among North American Testicular Cancer Survivors After Modern Cisplatin-Based Chemotherapy. J Clin Oncol. 2017; 35(11):1211-1222. PMC: 5455601. DOI: 10.1200/JCO.2016.70.3108. View

Ogan K, Lotan Y, Koeneman K, Pearle M, Cadeddu J, Rassweiler J . Laparoscopic versus open retroperitoneal lymph node dissection: a cost analysis. J Urol. 2002; 168(5):1945-9; discussion 1949. DOI: 10.1016/S0022-5347(05)64269-3. View

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

Calaway A, Einhorn L, Masterson T, Foster R, Cary C . Adverse Surgical Outcomes Associated with Robotic Retroperitoneal Lymph Node Dissection Among Patients with Testicular Cancer. Eur Urol. 2019; 76(5):607-609. DOI: 10.1016/j.eururo.2019.05.031. View

Blok J, van der Poel H, Kerst J, Bex A, Brouwer O, Bosch J . Clinical outcome of robot-assisted residual mass resection in metastatic nonseminomatous germ cell tumor. World J Urol. 2020; 39(6):1969-1976. PMC: 8217018. DOI: 10.1007/s00345-020-03437-z. View

Mistretta F, de Cobelli O, Verze P, Botticelli F, Jannello L, Luzzago S . A comprehensive evaluation of sexual and reproductive outcomes following robot-assisted retroperitoneal lymph node dissection for nonseminomatous germ cell tumor. Asian J Androl. 2022; 24(6):579-583. PMC: 9809475. DOI: 10.4103/aja2021132. View

10.

Lloyd P, Hong A, Furrer M, Lee E, Dev H, Coret M . A comparative study of peri-operative outcomes for 100 consecutive post-chemotherapy and primary robot-assisted and open retroperitoneal lymph node dissections. World J Urol. 2021; 40(1):119-126. DOI: 10.1007/s00345-021-03832-0. View

11.

Pickersgill N, Raval N, Kim E, Black R, Du K, Figenshau R . Post-chemotherapy Laparoscopic Retroperitoneal Lymph Node Dissection for Mixed Malignant Germ Cell Testicular Tumors. Clin Genitourin Cancer. 2020; 19(3):273.e1-273.e5. DOI: 10.1016/j.clgc.2020.09.003. View

12.

Harris K, Gorin M, Ball M, Pierorazio P, Allaf M . A comparative analysis of robotic vs laparoscopic retroperitoneal lymph node dissection for testicular cancer. BJU Int. 2015; 116(6):920-3. DOI: 10.1111/bju.13121. View

13.

Gilligan T, Lin D, Aggarwal R, Chism D, Cost N, Derweesh I . Testicular Cancer, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2019; 17(12):1529-1554. DOI: 10.6004/jnccn.2019.0058. View

14.

Krege S, Beyer J, Souchon R, Albers P, Albrecht W, Algaba F . European consensus conference on diagnosis and treatment of germ cell cancer: a report of the second meeting of the European Germ Cell Cancer Consensus group (EGCCCG): part I. Eur Urol. 2008; 53(3):478-96. DOI: 10.1016/j.eururo.2007.12.024. View

15.

Dieckmann K, Anheuser P, Kulejewski M, Gehrckens R, Feyerabend B . Is there still a place for retroperitoneal lymph node dissection in clinical stage 1 nonseminomatous testicular germ-cell tumours? A retrospective clinical study. BMC Urol. 2018; 18(1):95. PMC: 6204050. DOI: 10.1186/s12894-018-0412-x. View

16.

Chovanec M, Vasilkova L, Petrikova L, Obertova J, Palacka P, Rejlekova K . Long-term sexual functioning in germ-cell tumor survivors. BMC Cancer. 2020; 20(1):779. PMC: 7439516. DOI: 10.1186/s12885-020-07301-6. View

17.

Pearce S, Golan S, Gorin M, Luckenbaugh A, Williams S, Ward J . Safety and Early Oncologic Effectiveness of Primary Robotic Retroperitoneal Lymph Node Dissection for Nonseminomatous Germ Cell Testicular Cancer. Eur Urol. 2016; 71(3):476-482. DOI: 10.1016/j.eururo.2016.05.017. View

18.

Stephenson A, Bosl G, Motzer R, Bajorin D, Stasi J, Sheinfeld J . Nonrandomized comparison of primary chemotherapy and retroperitoneal lymph node dissection for clinical stage IIA and IIB nonseminomatous germ cell testicular cancer. J Clin Oncol. 2007; 25(35):5597-602. DOI: 10.1200/JCO.2007.12.0808. View

19.

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

20.

Nason G, Hamilton R . Robotic RPLND for stage IIA/B nonseminoma: the Princess Margaret Experience. World J Urol. 2022; 40(2):335-342. DOI: 10.1007/s00345-021-03899-9. View