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- Title
Robot-assisted retroperitoneal lymph node dissection: technique and initial case series of 18 patients.
- Authors
Cheney, Scott M.; Andrews, Paul E.; Leibovich, Bradley C.; Castle, Erik P.
- Abstract
Objective To evaluate outcomes of the first 18 patients treated with robot-assisted retroperitoneal lymph node dissection ( RA-RPLND) for non-seminomatous germ cell tumours ( NSGCT) and paratesticular rhabdomyosarcoma ( RMS) at our institution. Patients and Methods Between March 2008 and May 2013, 17 patients underwent RA-RPLND for NSGCT and one for paratesticular RMS. Data were collected retrospectively on patient demographics, preoperative tumour characteristics, and perioperative outcomes including open conversion rate, lymph node ( LN) yield, rate of positive LNs, operative time, estimated blood loss ( EBL), and length of stay ( LOS). Perioperative outcomes were compared between patients receiving primary RA-RPLND vs post-chemotherapy RA-RPLND. Medium-term outcomes of tumour recurrence rate and maintenance of antegrade ejaculation were recorded. Results RA-RPLND was completed robotically in 15 of 18 (83%) patients. LNs were positive in eight of 18 patients (44%). The mean LN yield was 22 LNs. For cases completed robotically, the mean operative time was 329 min, EBL was 103 mL, and LOS was 2.4 days. At a mean (range) follow-up of 22 (1-58) months, there were no retroperitoneal recurrences and two of 17 (12%) patients with NSGCT had pulmonary recurrences. Antegrade ejaculation was maintained in 91% of patients with a nerve-sparing approach. Patients receiving primary RA-RPLND had shorter operative times compared with those post-chemotherapy (311 vs 369 min, P = 0.03). There was no significant difference in LN yield (22 vs 18 LNs, P = 0.34), EBL (100 vs 313 mL, P = 0.13), or LOS (2.75 vs 2.2 days, P = 0.36). Conclusion This initial selected case series of RA-RPLND shows that the procedure is safe, reproducible, and feasible for stage I- IIB NSGCT and RMS in the hands of experienced robotic surgeons. Larger studies are needed to confirm the diagnostic and therapeutic utility of this technique.
- Subjects
LYMPH node surgery; GERM cell tumors; RHABDOMYOSARCOMA; CANCER relapse; EJACULATION
- Publication
BJU International, 2015, Vol 115, Issue 1, p114
- ISSN
1464-4096
- Publication type
Article
- DOI
10.1111/bju.12804