Unilateral post-chemotherapy robot-assisted retroperitoneal lymph node dissection in Stage II non-seminomatous germ cell tumor: A tertiary care experience
aDepartment of Urology, National Cancer Institute, Pascale Foundation, Naples, Italy bUrology Unit, Department of Maternal-Child and Urological Sciences, “Sapienza” University, Rome, Italy cDepartment of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy dScientific Directorate, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Naples, Italy eDivision of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy fDivision of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione G. Pascale”, IRCCS, Naples, Italy
Objective: Post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) represents an integral component of the management of patients with non-seminomatous germ cell tumor (NSGCT). Modified templates have been proposed to minimize the surgical morbidity of the procedure. Moreover, the implementation of robotic surgery in this setting has been explored. We report our experience with unilateral post-chemotherapy robot-assisted retroperitoneal lymph node dissection (PC-rRPLND) for clinical Stages IIA and IIB NSGCTs.
Methods: A retrospective single institution review was performed including 33 patients undergoing PC-rRPLND for Stages IIA and IIB NSGCTs between January 2015 and February 2019. Following orchiectomy, patients were scheduled for chemotherapy with three cycles of bleomycin-etoposide-cisplatin. Patients with a residual tumor of <5 cm and an ipsilateral metastatic disease on pre- and post-chemotherapy CT scans were eligible for a unilateral template in absence of rising tumor markers. Descriptive statistics were provided for demographics, clinical characteristics, intraoperative and postoperative parameters. Perioperative, oncological, and functional outcomes were recorded.
Results: Overall, 7 (21.2%) patients exhibited necrosis or fibrosis; 14 (42.4%) had mature teratoma; and 12 (36.4%) had viable tumor at final histology. The median lymph node size at surgery was 25 (interquartile range [IQR] 21-36) mm. Median operative time was 180 (IQR 165-215) min and no major postoperative complications were observed. Anterograde ejaculation was preserved in 75.8% of patients. Median follow-up was 26 (IQR 19-30) months and a total of three recurrences were recorded.
Conclusion: PC-rRPLND is a reliable and technically reproducible procedure with safe oncological outcomes and acceptable postoperative ejaculatory function in well selected patients with NSGCTs.
. [J]. Asian Journal of Urology, 2023, 10(4): 440-445.
Dario Franzese, Antonio Tufano, Alessandro Izzo, Raffaele Muscariello, Giovanni Grimaldi, Giuseppe Quarto, Luigi Castaldo, Sabrina Rossetti, Savio Domenico Pandolfo, Sonia Desicato, Paola Del Prete, Matteo Ferro, Sandro Pignata, Sisto Perdonà. Unilateral post-chemotherapy robot-assisted retroperitoneal lymph node dissection in Stage II non-seminomatous germ cell tumor: A tertiary care experience. Asian Journal of Urology, 2023, 10(4): 440-445.
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