A comparative study of peri-operative outcomes for 100 consecutive post-chemotherapy and primary robot-assisted and open retroperitoneal lymph node dissections

Lloyd, P; Hong, A; Furrer, MA; Lee, EWY; Dev, HS; Coret, MH; Adshead, JM; Baldwin, P; Knight, R; Shamash, J; Alifrangis, C; Stoneham, S; Mazhar, D; Wong, H; Warren, A; Tran, B; Lawrentschuk, N; Neal, DE; Thomas, BC

Author(s): Lloyd, P; Hong, A; Furrer, MA; Lee, EWY; Dev, HS; Coret, MH; Adshead, JM; Baldwin, P; Knight, R; Shamash, J; Alifrangis, C; Stoneham, S; Mazhar, D; Wong, H; Warren, A; Tran, B; Lawrentschuk, N; Neal, DE; Thomas, BC;
Details: Publication Year 2022-01,Volume 40,Issue #1,Page 119-126
Journal Title: World Journal of Urology
Publication Type: Research article
Abstract: PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Publisher: Springer Nature
Keywords: Combined Modality Therapy; Humans; Lymph Node Excision/*methods; Lymphatic Metastasis; Male; Neoplasms, Germ Cell and Embryonal/drug therapy/secondary/*surgery; Retroperitoneal Space; *Robotic Surgical Procedures; Testicular Neoplasms/drug therapy/pathology/secondary/*surgery; Treatment Outcome; Retroperitoneal lymph node dissection; Robotic surgery; Testicular cancer
Department(s): Medical Oncology
PubMed ID: 34599350
Publisher's Version: https://doi.org/10.1007/s00345-021-03832-0
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2025-01-24 05:56:59

Last Modified: 2025-01-24 05:58:22