Robot-assisted post-chemotherapy retroperitoneal lymph node dissection for metastatic non-seminomatous germ cell tumors using two distinct surgical approaches: A tertiary care experience.

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.