Robotic-Assisted Retroperitoneal Lymph Node Dissection for Small Volume Metastatic Testicular Cancer.

Robotic-assisted retroperitoneal lymph node dissection (R-RPLND) in patients with testicular cancer (TC) is controversially discussed. Lately, unusual recurrence patterns with adverse outcome have been published after R-RPLND. Aim of this report is to determine the feasibility, safety and early oncological outcome of R-RPLND in patients with small volume metastatic TC.

We retrospectively evaluated 27 consecutive patients with small volume metastatic TC (10/2010-11/2019) who underwent R-RPLND (unilateral modified template). Intra- and postoperative complications as well as early oncologic outcomes are reported. Surgery was performed in the primary metastatic setting in 22 (81%), post-chemotherapy in 4 (15%) and for late relapse in one patient (4%). Initial clinical stage was IIA for 14 (52%), IIB for 12 (43%), and III for 1 (4%) patient.

Median operative time, blood loss, and length of hospital stay were 175 min, 50 ml, and 4 d. Expectedly, viable tumor was found in 21/27 patients (78%), 6 patients (22%) showed fibrosis, necrosis or no tumor. Overall, 3 (11%) patients experienced intra- (Satava II) and 1 (4%) patient postoperative (Clavien-Dindo IIIb) complications, respectively. The median follow-up is 16.5 months (3-69), 3 (11%) patients experienced relapse outside of the surgical field after 12, 22 and 36 months.

In highly selected patients with low volume metastatic TC R-RPLND may be indicated and appears to be technically feasible and comparable with open surgery in terms of complications and early oncological safety. Prospective data collection in larger series are necessary to clarify the role and specific indications of this approach.

The Journal of urology. 2020 Jul 27 [Epub ahead of print]

Andreas Hiester, Alessandro Nini, Christian Arsov, Carolin Buddensieck, Peter Albers

Department of Urology, University of Duesseldorf, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany.

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