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01-04-2020 | Cytostatic Therapy | Topic Paper

Primary robotic RLPND for nonseminomatous germ cell testicular cancer: a two-center analysis of intermediate oncologic and safety outcomes

Authors: Nicholas R. Rocco, Sean P. Stroup, Haidar M. Abdul-Muhsin, Michael T. Marshall, Michael G. Santomauro, Matthew S. Christman, James O. L’Esperance, Erik P. Castle

Published in: World Journal of Urology | Issue 4/2020

Abstract

Objective

To evaluate the intermediate-term oncologic outcomes and safety profile of the largest case series of primary robotic retroperitoneal lymphadenectomy for low-clinical-stage non-seminomatous germ cell testicular cancer.

Methods

This was a two-center retrospective analysis of robotic RPLND cases for low-clinical-stage (stage I–IIB) non-seminomatous germ cell testicular cancer in the primary setting. Demographic, perioperative, operative and oncologic variables were collected between March 2008 and May 2019. Descriptive analyses were performed and presented as medians with interquartile ranges for continuous variables and frequency and proportions for categorical variables. A survival analysis of time to recurrence was performed using Cox proportional hazards model. Using logistic regression, risk factors for complications were analyzed. Both univariate and multivariate analyses were performed.

Results

A total of 58 patients (CS 1 = 56, CS IIA = 2, CS IIB = 0) were identified. The median follow-up was 47 months and the 2-year recurrence-free survival rate was 91%. The five recurrences were all out of the performed dissection template (pelvis = 1 and lung = 4). Only five patients (29%) with occult metastasis underwent adjuvant chemotherapy. The median operative time was 319 min [interquartile range (IQR) 276–355 min], estimated blood loss was 100 ml (IQR 75–200 ml), node count was 26 (IQR 20–31), and length of stay 2 d (IQR 1–3 days). There were 2 (3.3%) intraoperative complications, 19 (32.7%) 30-day postoperative complications to include 14 (24.1%) Clavien grade I, 4 (6.9%) Clavien grade II, 1 (1.7%) Clavien grade III and 0 Clavien grade IV complications. No statistical significance was found on multivariate or univariate analysis for survival analysis of time to recurrence and risk factors for complications.

Conclusions

This study represents the largest case series of primary R-RPLND for the treatment of low-stage non-seminomatous germ cell tumors (NSGCT). With 47 months of follow-up and a low rate of adjuvant chemotherapy, intermediate oncologic efficacy appears to be comparable to the gold standard open approach.

Network NCC. Testicular cancer version 1.2019. https://www.nccn.org/professionals/physician_gls/default.aspx. Accessed 1 Apr 2019

Fung C, Dinh P Jr, Ardeshir-Rouhani-Fard S, Schaffer K, Fossa SD, Travis LB (2018) Toxicities associated with cisplatin-based chemotherapy and radiotherapy in long-term testicular cancer survivors. Adv Urol. 2018:8671832. https://doi.org/10.1155/2018/8671832(Epub 2018/04/20, PubMed PMID: 29670654; PubMed Central PMCID: PMCPMC5835297) CrossRefPubMedPubMedCentral

Haugnes HS, Oldenburg J, Bremnes RM (2015) Pulmonary and cardiovascular toxicity in long-term testicular cancer survivors. Urol Oncol 33(9):399–406. https://doi.org/10.1016/j.urolonc.2014.11.012(Epub 2015/01/03, PubMed PMID: 25554583) CrossRefPubMed

de Wit R (2014) Optimal management of clinical stage I nonseminoma: new data for patients to consider. J Clin Oncol 32(34):3792–3793. https://doi.org/10.1200/jco.2014.56.5747(Epub 2014/10/01, PubMed PMID: 25267744) CrossRefPubMed

Subramanian VS, Nguyen CT, Stephenson AJ, Klein EA (2010) Complications of open primary and post-chemotherapy retroperitoneal lymph node dissection for testicular cancer. Urol Oncol 28(5):504–509. https://doi.org/10.1016/j.urolonc.2008.10.026(Epub 2008/12/23, PubMed PMID: 19097812) CrossRefPubMed

Rukstalis DB, Chodak GW (1992) Laparoscopic retroperitoneal lymph node dissection in a patient with stage 1 testicular carcinoma. J Urol 148(6):1907–1909 (discussion 9–10, Epub 1992/12/01, PubMed PMID: 1433638) CrossRef

Bhayani SB, Ong A, Oh WK, Kantoff PW, Kavoussi LR (2003) Laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell testicular cancer: a long-term update. Urology 62(2):324–327 (Epub 2003/08/02, PubMed PMID: 12893344) CrossRef

Mano R, Di Natale R, Sheinfeld J (2019) Current controversies on the role of retroperitoneal lymphadenectomy for testicular cancer. Urol Oncol 37(3):209–218. https://doi.org/10.1016/j.urolonc.2018.09.009(Epub 2018/11/18, PubMed PMID: 30446455; PubMed Central PMCID: PMCPMC6379133) CrossRefPubMed

Harris KT, Gorin MA, Ball MW, Pierorazio PM, Allaf ME (2015) A comparative analysis of robotic vs laparoscopic retroperitoneal lymph node dissection for testicular cancer. BJU Int 116(6):920–923. https://doi.org/10.1111/bju.13121(Epub 2015/03/18, PubMed PMID: 25781349) CrossRefPubMed

10.

Ng AT, Tam PC (2014) Current status of robot-assisted surgery. Hong Kong Med J 20(3):241–250. https://doi.org/10.12809/hkmj134167(Epub 2014/05/24, PubMed PMID: 24854139) CrossRefPubMed

11.

Davol P, Sumfest J, Rukstalis D (2006) Robotic-assisted laparoscopic retroperitoneal lymph node dissection. Urology 67(1):199. https://doi.org/10.1016/j.urology.2005.07.022(Epub 2006/01/18, PubMed PMID: 16413370) CrossRefPubMed

12.

Cheney SM, Andrews PE, Leibovich BC, Castle EP (2015) Robot-assisted retroperitoneal lymph node dissection: technique and initial case series of 18 patients. BJU Int 115(1):114–120. https://doi.org/10.1111/bju.12804(Epub 2014/05/16, PubMed PMID: 24825773) CrossRefPubMed

13.

Stepanian S, Patel M, Porter J (2016) Robot-assisted laparoscopic retroperitoneal lymph node dissection for testicular cancer: evolution of the technique. Eur Urol 70(4):661–667. https://doi.org/10.1016/j.eururo.2016.03.031(Epub 2016/04/14, PubMed PMID: 27068395) CrossRefPubMed

14.

Pearce SM, Golan S, Gorin MA, Luckenbaugh AN, Williams SB, Ward JF et al (2017) Safety and early oncologic effectiveness of primary robotic retroperitoneal lymph node dissection for nonseminomatous germ cell testicular cancer. Eur Urol 71(3):476–482. https://doi.org/10.1016/j.eururo.2016.05.017(Epub 2016/05/29, PubMed PMID: 27234998) CrossRefPubMed

15.

Santomauro MG, Stroup SP, L’Esperance AH, Masterson JH, Derweesh IH, Auge BK, Crain DS, L’Esperance JO (2014) Supine robotic-assisted retroperitoneal lymph node dissection for testicular cancer. CRSLS. https://doi.org/10.4293/CRSLS.2014.00326 CrossRef

16.

Carver BS, Shayegan B, Eggener S, Stasi J, Motzer RJ, Bosl GJ et al (2007) Incidence of metastatic nonseminomatous germ cell tumor outside the boundaries of a modified postchemotherapy retroperitoneal lymph node dissection. J Clin Oncol 25(28):4365–4369. https://doi.org/10.1200/jco.2007.11.2078(Epub 2007/10/02, PubMed PMID: 17906201) CrossRefPubMed

17.

Eggener SE, Carver BS, Sharp DS, Motzer RJ, Bosl GJ, Sheinfeld J (2007) Incidence of disease outside modified retroperitoneal lymph node dissection templates in clinical stage I or IIA nonseminomatous germ cell testicular cancer. J Urol 177(3):937–942. https://doi.org/10.1016/j.juro.2006.10.045(discussion 42–3. Epub 2007/02/14, PubMed PMID: 17296380) CrossRefPubMed

18.

Amin MB, Edge SB, Greene FL, Byrd DR, Brookland RK, Washington MK et al (eds) (2017) AJCC cancer staging manual, 8th edn. Springer, New York

19.

Rassweiler JJ, Scheitlin W, Heidenreich A, Laguna MP, Janetschek G (2008) Laparoscopic retroperitoneal lymph node dissection: does it still have a role in the management of clinical stage I nonseminomatous testis cancer? A European perspective. Eur Urol 54(5):1004–1015. https://doi.org/10.1016/j.eururo.2008.08.022(Epub 2008/08/30, PubMed PMID: 18722704) CrossRefPubMed

20.

Al-Ahmadie HA, Carver BS, Cronin AM, Olgac S, Tickoo SK, Fine SW et al (2013) Primary retroperitoneal lymph node dissection in low-stage testicular germ cell tumors: a detailed pathologic study with clinical outcome analysis with special emphasis on patients who did not receive adjuvant therapy. Urology 82(6):1341–1346. https://doi.org/10.1016/j.urology.2013.04.082(Epub 2013/10/08, PubMed PMID: 24094656) CrossRefPubMed

21.

Nayan M, Jewett MA, Sweet J, Anson-Cartwright L, Bedard PL, Moore M et al (2015) Lymph node yield in primary retroperitoneal lymph node dissection for nonseminoma germ cell tumors. J Urol 194(2):386–391. https://doi.org/10.1016/j.juro.2015.03.100(Epub 2015/04/01, PubMed PMID: 25823792) CrossRefPubMed

22.

Thompson RH, Carver BS, Bosl GJ, Bajorin D, Motzer R, Feldman D et al (2010) Evaluation of lymph node counts in primary retroperitoneal lymph node dissection. Cancer 116(22):5243–5250. https://doi.org/10.1002/cncr.25266(Epub 2010/07/29, PubMed PMID: 20665486; PubMed Central PMCID: PMCPMC4174298) CrossRefPubMedPubMedCentral

23.

Tselos A, Moris D, Tsilimigras DI, Fragkiadis E, Mpaili E, Sakarellos P et al (2018) Robot-assisted retroperitoneal lymphadenectomy in testicular cancer treatment: a systematic review. J Laparoendosc Adv Surg Tech A 28(6):682–689. https://doi.org/10.1089/lap.2017.0672(Epub 2018/02/24, PubMed PMID: 29474141) CrossRefPubMed

24.

Beck SD, Peterson MD, Bihrle R, Donohue JP, Foster RS (2007) Short-term morbidity of primary retroperitoneal lymph node dissection in a contemporary group of patients. J Urol 178(2):504–506. https://doi.org/10.1016/j.juro.2007.03.123(discussion 6, Epub 2007/06/15, PubMed PMID: 17561131) CrossRefPubMed

25.

Smith JA Jr, Herrell SD (2005) Robotic-assisted laparoscopic prostatectomy: do minimally invasive approaches offer significant advantages? J Clin Oncol 23(32):8170–8175. https://doi.org/10.1200/jco.2005.03.1963(Epub 2005/11/10, PubMed PMID: 16278469) CrossRefPubMed

26.

Williams SB, McDermott DW, Winston D, Bahnson E, Berry AM, Steele GS et al (2010) Morbidity of open retroperitoneal lymph node dissection for testicular cancer: contemporary perioperative data. BJU Int 105(7):918–921. https://doi.org/10.1111/j.1464-410x.2009.08888.x(Epub 2009/09/15, PubMed PMID: 19747353) CrossRefPubMed

27.

Syan-Bhanvadia S, Bazargani ST, Clifford TG, Cai J, Miranda G, Daneshmand S (2017) Midline extraperitoneal approach to retroperitoneal lymph node dissection in testicular cancer: minimizing surgical morbidity. Eur Urol 72(5):814–820. https://doi.org/10.1016/j.eururo.2017.02.024(Epub 2017/03/23, PubMed PMID: 28325537) CrossRefPubMed

28.

Moore LJ, Wilson MR, Waine E, Masters RS, McGrath JS, Vine SJ (2015) Robotic technology results in faster and more robust surgical skill acquisition than traditional laparoscopy. J Robot Surg 9(1):67–73. https://doi.org/10.1007/s11701-014-0493-9(Epub 2015/11/05, PubMed PMID: 26530974) CrossRefPubMed

29.

Baniel J, Foster RS, Rowland RG, Bihrle R, Donohue JP (1994) Complications of primary retroperitoneal lymph node dissection. J Urol 152(2 Pt 1):424–427 (Epub 1994/08/01 PubMed PMID: 8015086) CrossRef

30.

Heidenreich A, Albers P, Hartmann M, Kliesch S, Kohrmann KU, Krege S et al (2003) Complications of primary nerve sparing retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell tumors of the testis: experience of the German Testicular Cancer Study Group. J Urol 169(5):1710–1714. https://doi.org/10.1097/01.ju.0000060960.18092.54(Epub 2003/04/11, PubMed PMID: 12686815) CrossRefPubMed

Title: Primary robotic RLPND for nonseminomatous germ cell testicular cancer: a two-center analysis of intermediate oncologic and safety outcomes
Authors: Nicholas R. Rocco
Sean P. Stroup
Haidar M. Abdul-Muhsin
Michael T. Marshall
Michael G. Santomauro
Matthew S. Christman
James O. L’Esperance
Erik P. Castle
Publication date: 01-04-2020
Publisher: Springer Berlin Heidelberg
Keyword: Cytostatic Therapy
Published in: World Journal of Urology / Issue 4/2020
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-019-02900-w

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Primary robotic RLPND for nonseminomatous germ cell testicular cancer: a two-center analysis of intermediate oncologic and safety outcomes

Abstract

Objective

Methods

Results

Conclusions

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Abstract

Objective

Methods

Results

Conclusions

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