Introduction:

Post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) for metastatic testicular cancer is a complex surgery traditionally performed via open approach. Nevertheless, the use of robotics has increased in recent years. The aim of our study is to evaluate the perioperative and oncological outcomes of robotic PC-RPLND.

Methods:

This retrospective multicenter study included consecutive patients who underwent robotic PC-RPLND for metastatic germ cell tumor with negative tumor markers at seven (US=6 and Australia=1) academic centers. Patients’ characteristics, perioperative data, and short-term oncological outcomes were reviewed.

Results:

A total of 90 patients with a median age of 30 years old were included. The baseline features and clinicopathological findings are shown in Table-1. Surgery was uneventful in all cases. Seven patients (8%) were electively converted to open due to failure to progress (n=6) and positive frozen section (n=1). Median estimated blood loss, operative time, and length of hospital stay were 150 mL, 5.6 hours, and 2 days, respectively. The 90-day complication rate was 14% (13 patients), most of which were low grade and managed conservatively (Table-2). No 90-day hospital readmission was recorded. Antegrade ejaculation was preserved in 27/30 (90%) patients with available data. With a median (IQR) follow-up of 12 (4-26) months, 5 (5.5%) patients had disease recurrence (4 systemic and 1 both in- and out-field), and one death occurred due to disease progression.

Conclusion:

This is the largest reported series of robotic PC-RPLND to date. With appropriate patient selection at centers with expertise in testicular cancer and minimally invasive surgery, robotic PC-RPLND appears safe and effective although longer follow-up is warranted.

Funding: N/A