Introduction:
Primary retroperitoneal node dissection (RPLND) in recent years has gained momentum for treatment of stage IIA and IIB testicular cancers, showing high cure rates. Current trials for primary RPLND are predominantly performed via open surgery. Robotic RPLND (R-RPLND) has gained favour over open surgery due to its significantly lower morbidity however there is limited data available regarding the outcomes of primary R-RPLND for stage IIA&B disease. Herein, we report our initial experience of this cohort at our institution.
Method:
We performed a retrospective review of our prospectively collected database from April 2018 to April 2023 at a major academic centre. All cases were performed by a single surgeon with experience in open and R-RPLND. Perioperative and oncological outcomes were reported, and 30-day complications were based on Clavien-Dindo classification.
Results:
11 patients underwent primary R-RPLND. Median age was 33(19-46) years, 6(55%) patients had left sided cancer and 5(45%) had right sided cancer. Clinical and pathological staging were: 3(27%) IIA and 8(73%) IIB, while 5(45%) had seminoma, 5 (55%) NSGCT and 1 (9%) pure teratoma. Median node size was 2.5cm (1.2-4.5). Surgical template was unilateral in 2(18%), bilateral in 1(9%) and 8(73%) had modified template resection. 10(91%) patients had nerve-sparing surgery. Median operating time was 300 minutes with median EBL of 50 (20-200) ml. Average length of stay was 2 days (1-2). One(9%) patient had a Clavien-Dindo III complication with chyle ascites requiring percutaneous drainage. With median follow up of 14 (3-39) months, 1(9%) patient developed mediastinal recurrence at 13 months post op and underwent surgical excision with no recurrence to date.
Conclusion:
Primary R-RPLND appears to be safe and feasible in selected patients with stage IIA and IIB testicular cancer. larger series and longer follow ups are required for validation of our findings.