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Post-chemotherapy robot-assisted retroperitoneal lymph node dissection for metastatic germ cell tumors: safety and perioperative outcomes

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World Journal of Urology Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 21 September 2023

Abstract

Purpose

To evaluate the feasibility, safety, and early oncologic outcomes after post-chemotherapy robot-assisted retroperitoneal lymph node dissection (PC-RARPLND) for metastatic germ cell tumors (mGCT).

Methods

We retrospectively analyzed patients from four tertiary centers who underwent PC-RARPLND for mGCT, from 2011 to 2021. Previous treatment of mGCT, intraoperative and postoperative complications, and early oncologic outcomes were assessed.

Results

Overall, 66 patients were included. The majority of patients had non-seminoma mTGCT (89%). Median size of retroperitoneal lymph node (RLN) before surgery was 26 mm. Templates of PC-RARPLND were left modified, right modified, and full bilateral in 56%, 27%, and 14%, respectively. Median estimated blood loss and length of stay were 50 mL [50–150] and 2 [1–3] days. Four patients (6.1%) had a vascular injury, only one with significant blood loss and conversion to open surgery (OS). Two other patients had a conversion to OS for difficulty of dissection. No patient had transfusion, most frequent complications were ileus (10.6%) and symptomatic lymphorrea (7.6%) and no complications grade IIIb or more occurred. With a median follow-up of 16 months, two patients had a relapse, all outside of the surgical template (one in the retrocrural space with reascending markers, one in lungs).

Conclusion

PC-RARPLND is a challenging surgery. In expert centers and for selected patients, it seemed safe and feasible, with a low morbidity. Further prospective evaluation of this procedure and long-term oncologic results are needed.

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Data availability

The data that support the findings of this study are available from the corresponding author, Nicolas Branger, upon reasonable request.

Abbreviations

GCT:

Germ cell tumor

RLN:

Retroperitoneal lymph node

RPLND:

Retroperitoneal lymph node dissection

RARPLND:

Robot-assisted retroperitoneal lymph node dissection

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Authors and Affiliations

  1. Department of Urology, Institut Paoli Calmettes Cancer Center, Marseille, France

    Nicolas Branger, Sophie Knipper & Jochen Walz

  2. Department of Urology, CHU Bordeaux, Bordeaux, France

    Franck Bladou, Grégoire Robert, Jean-Christophe Bernhard & Abderrahmane Khaddad

  3. Department of Urology, CHU Rennes, Rennes, France

    Gregory Verhoest & Anne Mauger De Varennes

  4. Department of Oncology, Centre Léon Bérard, Lyon, France

    Aude Fléchon

  5. Department of Urology, CHU Toulouse, Toulouse, France

    Jean-Baptiste Beauval, Anne-Sophie Bageot & Nicolas Doumerc

  6. Department of Urology, La Pitié Salpêtrière, Paris, France

    Morgan Rouprêt

  7. Department of Urology, CHU Montpellier, Montpellier, France

    Thibault Murez

Authors
  1. Nicolas Branger
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  2. Franck Bladou
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  13. Nicolas Doumerc
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  14. Morgan Rouprêt
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  15. Thibault Murez
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Consortia

on behalf of French AFU Testicular Cancer Committee

Contributions

NB: protocol/project development, data collection or management, data analysis, manuscript writing/editing; FB: data collection or management/ manuscript writing/editing; GV: data collection or management/ manuscript writing/editing; SK: data analysis/manuscript writing/editing; GR: manuscript writing/editing; JCB: manuscript writing/editing; JBB: manuscript writing/editing; AK: data collection or management; AMDV: data collection or management; AF: manuscript writing/editing; JW: manuscript writing/editing; ASB: data collection or management; ND: manuscript writing/editing; MR: protocol/project development; TM: protocol/project development, manuscript writing/editing.

Corresponding author

Correspondence to Nicolas Branger.

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Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

This is a retrospective analysis, no interventional actions were done, only data collection.

Informed consent

Institutional review board approved the study (ROBOTESTIS-IPC-2021–039), waiving the need of an informed consent, considering the retrospective characteristic of this study.

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Branger, N., Bladou, F., Verhoest, G. et al. Post-chemotherapy robot-assisted retroperitoneal lymph node dissection for metastatic germ cell tumors: safety and perioperative outcomes. World J Urol 41, 2405–2411 (2023). https://doi.org/10.1007/s00345-023-04536-3

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  • DOI: https://doi.org/10.1007/s00345-023-04536-3

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