Asian journal of urology · 2025
Robot-assisted post-chemotherapy retroperitoneal lymph node dissection for metastatic non-seminomatous germ cell tumors using two distinct surgical approaches: A tertiary care experience.
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Li Xiangdong, Teixeira Wilhem M S, Ding Renjie, Guo Shengjie, Han Hui, Yao Kai, Zhou Fangjian, Liu Zhuowei
Аннотация
OBJECTIVE: Robot-assisted post-chemotherapy retroperitoneal lymph node dissection (R-PC-RPLND) is increasingly used as an alternative to open surgery for metastatic testicular cancer. This study aimed to summarize the experience with lateral and supine approaches in R-PC-RPLND for metastatic non-seminomatous germ cell tumors, applied based on different clinical indications.
METHODS: We conducted a retrospective analysis of 42 consecutive patients who underwent R-PC-RPLND at our tertiary cancer center from May 2016 to July 2023. Patients were categorized based on the surgical approach used: lateral position (28 patients) or supine position (14 patients). Data on perioperative outcomes, complications, and oncological efficacy were assessed and reported using descriptive statistics.
RESULTS: The median patient age was 28.0 (interquartile range [IQR]: 23.5-30.5) years, and the median body mass index was 22.7 (IQR: 19.9-24.2) kg/m2. The median operative time was 167.5 (IQR: 135.0-216.0) min, and the median estimated blood loss was 100.0 (IQR: 50.0-200.0) mL. Vascular injuries occurred in 4.8% of the cases, with no conversions to open surgery required. Postoperative complications were observed in 14% of the patients, all classified as Clavien-Dindo grades I-II. Histopathological examination revealed necrosis or fibrosis in 43% of the cases, teratoma in 31%, and viable germ cell tumor in 26%. During a median follow-up of 22.0 (IQR: 16.0-30.5) months, 17% of the patients experienced relapse, with a median time to relapse of 5.0 (IQR: 4.0-7.0) months.
CONCLUSION: Both lateral and supine approaches for R-PC-RPLND demonstrated favorable surgical and oncological outcomes, with acceptable operative times, minimal blood loss, low complication rates, and effective oncological control. The choice between these approaches should consider patient-specific factors and surgeon expertise, allowing for tailored treatment that optimizes outcomes.
METHODS: We conducted a retrospective analysis of 42 consecutive patients who underwent R-PC-RPLND at our tertiary cancer center from May 2016 to July 2023. Patients were categorized based on the surgical approach used: lateral position (28 patients) or supine position (14 patients). Data on perioperative outcomes, complications, and oncological efficacy were assessed and reported using descriptive statistics.
RESULTS: The median patient age was 28.0 (interquartile range [IQR]: 23.5-30.5) years, and the median body mass index was 22.7 (IQR: 19.9-24.2) kg/m2. The median operative time was 167.5 (IQR: 135.0-216.0) min, and the median estimated blood loss was 100.0 (IQR: 50.0-200.0) mL. Vascular injuries occurred in 4.8% of the cases, with no conversions to open surgery required. Postoperative complications were observed in 14% of the patients, all classified as Clavien-Dindo grades I-II. Histopathological examination revealed necrosis or fibrosis in 43% of the cases, teratoma in 31%, and viable germ cell tumor in 26%. During a median follow-up of 22.0 (IQR: 16.0-30.5) months, 17% of the patients experienced relapse, with a median time to relapse of 5.0 (IQR: 4.0-7.0) months.
CONCLUSION: Both lateral and supine approaches for R-PC-RPLND demonstrated favorable surgical and oncological outcomes, with acceptable operative times, minimal blood loss, low complication rates, and effective oncological control. The choice between these approaches should consider patient-specific factors and surgeon expertise, allowing for tailored treatment that optimizes outcomes.