Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

Perioperative and Oncological Outcomes of Patients Undergoing Post-Chemotherapy Robotic-Retroperitoneal Lymph Node Dissection for Management of Primary Testicular Cancer (#170)

Navid Ahmadi 1 , Alice Grant 1 , Ahmed Goolam 1 , George McClintock 1 , Don Jeeves Perera 1 , David Zalcberg 1 , Henry Woo 1 , Scott Leslie 1 , Peter Ferguson 1 , Nariman Ahmadi 1
  1. Chris O'Brien Lifehouse, Stanmore, NSW, Australia

Introduction:

Retroperitoneal lymph node dissection (RPLND) is the standard of care for patients with primary testicular cancer who have a residual mass following chemotherapy. The robotic (R-PLND) approach has gained momentum and favour over open surgery during the past decade due to its lower morbidity and faster recovery. Herein, we present our institution’s experience in R-RPLND for treatment of a residual mass following primary chemotherapy for testicular cancer. 

Method: We performed a retrospective review of our prospectively collected database from April 2018 until April 2023 at a major academic centre. All cases were performed by a single surgeon with experience in open and robotic RPLND. Perioperative and oncological outcomes were reported and 30-day complications were based on the Clavien-Dindo classification.

Results: 17 patients underwent R-RPLND. Median age was 33(22-68) years. 12(71%) patients had left sided cancer, 3 (18%) had right sided cancer and 2 had bilateral testicular cancer. 3 (18%) had seminoma, 12(71%) NSGCT and 2 patients had teratoma only. Clinical staging: 5 (29%) IIA disease, 5(29%) IIB and 7(41%) IIC. Histopathology was: 8 (47%) teratoma, 3 (18%) residual cancer, 1 (6%) benign and 5(29%) harbouring necrosis only. Median operative time was 300 (230-600) minutes with the median estimated blood loss (EBL) of 50ml (IQR 30-300), and median node count of 39 (23-65). Median length of stay was 2 days (1-3) and 3 (18%) patients developed complications, of which 2(12%) were chylous ascites requiring intervention and 1(6%) developed small bowel obstruction which was managed conservatively. At median follow up of 33 months, 1(6%) patient developed in-field recurrence and 1(6%) patient developed out of-field recurrence, both were subsequently salvaged with second line chemotherapy.

Conclusion: R-RPLND is safe and feasible in suitable patients, offering low morbidity and early recovery. Medium-term oncological outcomes are encouraging and comparable to open-RPLND series. Larger series and longer follow up are required for validation of our outcomes.