Retroperitoneal lymph node dissection (RPLND) in testicular cancer is a documented treatment along with active surveillance and chemotherapy. This study aims to summarize the current evidence on the use of Robot-assisted RPLND (RARPLND) in comparison with the laparoscopic and open approach.
Materials and Methods:
A search was conducted in the existing literature focusing on reports with outcomes of RARPLND for stage I-IIB testicular tumor.
Results:
Eleven studies complied with the inclusion criteria, including 116 patients. The average follow-up of 21.2 months showed no retroperitoneal recurrence. The median lymph node yield was 22.3 and the overall positive rate was 26%. Complications were encountered in 8% of the patients. The robotic approach showed similar results to the laparoscopic approach and outperformed the open procedure in perioperative parameters.
Conclusions:
Relapse-free survival, nodal yield, and complication rates during RARPLND for clinical stage I-IIB are acceptable. Further studies are required to establish these findings and determine benefit from the use of robotic approach.
MotzerRJ, AgarwalN, BeardC, et al.NCCN clinical practice guidelines in oncology: Testicular cancer. J Natl Compr Canc Netw, 2009; 7:672–693.
3.
AlbersP, AlbrechtW, AlgabaF, et al.Guidelines on testicular cancer: 2015 Update. Eur Urol, 2015; 68:1054–1068.
4.
HeidenreichA, AlbersP, HartmannM, et al.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, 2003; 169:1710–1714.
5.
RukstalisDB, ChodakGW. Laparoscopic retroperitoneal lymph node dissection in a patient with stage 1 testicular carcinoma. J Urol, 1992; 148:1907–1909; discussion 1909–1910.
6.
RassweilerJJ, ScheitlinW, HeidenreichA, et al.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, 2008; 54:1004–1015.
MoherD, LiberatiA, TetzlaffJ, et al.Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. J Clin Epidemiol, 2009; 62:1006–1012.
9.
HarrisKT, GorinMA, BallMW, et al.A comparative analysis of robotic vs laparoscopic retroperitoneal lymph node dissection for testicular cancer. BJU Int, 2015; 116:920–923.
10.
DonohueJP, ThornhillJA, FosterRS, et al.The role of retroperitoneal lymphadenectomy in clinical stage B testis cancer: The Indiana University experience (1965 to 1989). J Urol, 1995; 153:85–89.
KamelMH, JacksonCM, MooreJT, et al.Post-chemotherapy robotic retroperitoneal lymph node dissection (RRPLND) in testicular cancer. J Robot Surg, 2012; 6:359–362.
13.
StepanianS, PatelM, PorterJ. Robot-assisted laparoscopic retroperitoneal lymph node dissection for testicular cancer: Evolution of the technique. Eur Urol, 2016; 70:661–667.
14.
CostNG, DaJustaDG, GranbergCF, et al.Robot-assisted laparoscopic retroperitoneal lymph node dissection in an adolescent population. J Endourol, 2012; 26:635–640.
15.
DograPN, SinghP, SainiAK, et al.Robot assisted laparoscopic retroperitoneal lymph node dissection in testicular tumor. Urol Ann, 2013; 5:223–226.
16.
CheneySM, AndrewsPE, LeibovichBC, CastleEP. Robot-assisted retroperitoneal lymph node dissection: Technique and initial case series of 18 patients. BJU Int, 2015; 115:114–120.
17.
PearceSM, GolanS, GorinMA, et al.Safety and early oncologic effectiveness of primary robotic retroperitoneal lymph node dissection for nonseminomatous germ cell testicular cancer. Eur Urol, 2017; 71:476–482.
18.
ClavienPA, BarkunJ, de OliveiraML, et al.The Clavien-Dindo classification of surgical complications: Five-year experience. Ann Surg, 2009; 250:187–196.
AlbersP, SienerR, KregeS, et al.Randomized phase III trial comparing retroperitoneal lymph node dissection with one course of bleomycin and etoposide plus cisplatin chemotherapy in the adjuvant treatment of clinical stage I nonseminomatous testicular germ cell tumors: AUO trial AH 01/94 by the German Testicular Cancer Study Group. J Clin Oncol, 2008; 26:2966–2972.
21.
Abdul-MuhsinHM, L'EsperanceJO, FischerK, et al.Robot-assisted retroperitoneal lymph node dissection in testicular cancer. J Surg Oncol, 2015; 112:736–740.
22.
NicolaiN, MiceliR, ArtusiR, et al.A simple model for predicting nodal metastasis in patients with clinical stage I nonseminomatous germ cell testicular tumors undergoing retroperitoneal lymph node dissection only. J Urol, 2004; 171:172–176.
23.
WeissbachL, Bussar-MaatzR, FlechtnerH, et al.RPLND or primary chemotherapy in clinical stage IIA/B nonseminomatous germ cell tumors? Results of a prospective multicenter trial including quality of life assessment. Eur Urol, 2000; 37:582–594.
24.
HulbertJC, FraleyEE. Laparoscopic retroperitoneal lymphadenectomy: New approach to pathologic staging of clinical stage I germ cell tumors of the testis. J Endourol, 1992; 3:123–125.
25.
JanetschekG, ReissiglA, PeschelR, et al.Diagnostic laparoscopic retroperitoneal lymph node dissection for non seminomatous testicular tumor. Ann Urol (Paris), 1995; 29:81–90.
26.
BhayaniSB, OngA, OhWK, et al.Laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell testicular cancer: A long-term update. Urology, 2003; 62:324–327.
27.
AllafME, BhayaniSB, LinkRE, et al.Laparoscopic retroperitoneal lymph node dissection: Duplication of open technique. Urology, 2005; 65:575–577.
28.
WilliamsSB, LauCS, JosephsonDY. Initial series of robot-assisted laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell testicular cancer. Eur Urol, 2011; 60:1299–1302.
29.
DudderidgeT, PandianS, NottD. Technique and outcomes for robotic assisted post-chemotherapy retroperitoneal lymph node dissection (RPLND) in stage 2 non-seminomatous germ cell tumour. In: “EAU Robotic Urology Section Congress BJU International, October2012.” London UK, pp. 20–21.
30.
ChalfinHJ, LudwigW, PierorazioPM, AllafME. Robotic primary RPLND for stage I testicular cancer: A review of indications and outcomes. Curr Urol Rep, 2016; 17:41.
31.
SubramanianVS, NguyenCT, StephensonAJ, KleinEA. Complications of open primary and post-chemotherapy retroperitoneal lymph node dissection for testicular cancer. Urol Oncol, 2010; 28:504–509.
32.
WilliamsSB, McDermottDW, WinstonD, et al.Morbidity of open retroperitoneal lymph node dissection for testicular cancer: Contemporary perioperative data. BJU Int, 2010; 105:918–921.
33.
GardnerMW, RoytmanTM, ChenC, et al.Laparoscopic retroperitoneal lymph node dissection for low-stage cancer: A Washington University update. J Endourol, 2011; 25:1753–1757.
34.
GuzzoTJ, GonzalgoML, AllafME. Laparoscopic retroperitoneal lymph node dissection with therapeutic intent in men with clinical stage I nonseminomatous germ cell tumors. J Endourol, 2010; 24:1759–1763.
35.
BanielJ, FosterRS, RowlandRG, et al.Complications of primary retroperitoneal lymph node dissection. J Urol, 1994; 152:424–427.
36.
NayanM, JewettMA, SweetJ, et al.Lymph node yield in primary retroperitoneal lymph node dissection for nonseminoma germ cell tumors. J Urol, 2015; 194:386–391.
37.
ThompsonRH, CarverBS, BoslGJ, et al.Evaluation of lymph node counts in primary retroperitoneal lymph node dissection. Cancer, 2010; 116:5243–5250.
38.
KollmannsbergerC, TandstadT, BedardPL, et al.Patterns of relapse in patients with clinical stage I testicular cancer managed with active surveillance. J Clin Oncol, 2015; 33:51–57.
39.
de CobelliO, BresciaA, MazzoleniF, et al.A novel “intuitive” surgical technique for right robot-assisted retroperitoneal lymph node dissection for stage I testicular NSGCT. World J Urol, 2013; 31:435–439.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
