Robot-assisted post-chemotherapy retroperitoneal lymph node dissection in germ cell tumor: is the single-docking with lateral approach relevant?
Surgical treatment of post-chemotherapy residual mass of germ cell tumor (GCT) may be performed in various techniques. We assess the feasibility, safety, and efficacy of single-docking with lateral approach robot-assisted retroperitoneal lymph node dissection (R-RPLND) in residual mass of GCT in our center.
Materials and methods
A retrospective review of patients undergoing R-RPLND for residual mass of CGT was performed between January 2014 and April 2017. Patients with residual mass < 3 cm for seminoma or < 1 cm for non-seminoma were eligible. All surgeries were performed with single-docking RPNLD technique in lateral decubitus. We assessed preoperative characteristics (age, testicular pathology, template, chemotherapy regimen, lesion size, and clinical stage), peroperative (operative time, estimated blood loss, intraoperative complication, node count, pathology, and number of positive node), and postoperative outcomes (postoperative complications, hospital length of stay, recurrence-free survival at 2 year, and ejaculation dysfunction).
Eleven patients underwent R-RPLND with a median size of the residual mass of 20 mm. Median operative time was 153 min with 120 ml of estimated blood loss, without intraoperative complication. Median nodes count was 7 [1; 24]. Two patients had post-chemotherapy necrotic nodes and one no tumorous node. One patient had postoperative Clavien I complication (chyloperitoneum). We report 72.7% of antegrade ejaculation at 1 month from the surgery. Median clinical recurrence-free survival was 100% after 2 years from the surgery (n = 6).
Lateral approach with single-docking R-RPLND for residual mass of GCT is feasible and safe, with satisfying functional and oncologic outcomes.
KeywordsRobotic surgery Testicular cancer Retroperitoneal lymph node dissection Single-docking Post-chemotherapy residual mass
CO: data collection and management, data analysis, and manuscript writing. JBB: project development, data analysis, and manuscript writing. LM: project development. PR: project development. MS: project development. MR: project development, data management, and data analysis. ND: project development, data collection or management, and data analysis
Compliance with ethical standards
Conflict of interest
Nicolas Doumerc is a consultant for intuitive surgical.
Research involving human participants
Not concerned (retrospective study).