Robot-assisted retroperitoneal lymph node dissection feasible for metastatic testicular cancer

A robotic-assisted retroperitoneal lymph node dissection (RARLND) is technically feasible and recommended in highly selected patients with low volume metastatic testicular cancer, suggests a study. In addition, RARLND has comparable complications and early oncologic safety to open surgery.

“RARLND in patients with testicular cancer is controversial. Lately, unusual recurrence patterns with adverse outcomes after RARLND have been published,” the investigators said.

Twenty-seven consecutive patients with small volume metastatic testicular cancer (October 2010 to November 2019) who underwent RARLND (unilateral modified template) were retrospectively evaluated in this study. Intra- and postoperative complications and early oncologic outcomes were reported.

The investigators performed surgery in the primary metastatic setting in 22 patients (81 percent), postchemotherapy in four (15 percent), and for late relapse in one (4 percent). Initial clinical stage was IIA for 14 patients (52 percent), IIB for 12 (43 percent), and III for one (4 percent).

Median operative time was 175 minutes, blood loss 50 ml, and length of hospital stay 4 days. Of the 27 patients, 21 (78 percent) had a viable tumour and six (22 percent) showed fibrosis, necrosis, or no tumour. Three patients (11 percent) had intraoperative (Satava II) and one (4 percent) had postoperative (Clavien-Dindo IIb) complications.

Over a median follow-up of 16.5 months, three patients (11 percent) had relapse outside of the surgical field after 12, 22, and 36 months.

“Prospective data collection in larger series is necessary to clarify the role and specific indications of this approach,” the investigators said.