Unilateral post-chemotherapy robot-assisted retroperitoneal lymph node dissection in Stage II non-seminomatous germ cell tumor: A tertiary care experience

doi:10.1016/j.ajur.2023.05.002

Asian Journal of Urology, 2023, 10 (4): 440-445 doi: 10.1016/j.ajur.2023.05.002

Original Articles

Unilateral post-chemotherapy robot-assisted retroperitoneal lymph node dissection in Stage II non-seminomatous germ cell tumor: A tertiary care experience

Dario Franzese^a,Antonio Tufano^b,Alessandro Izzo^a,Raffaele Muscariello^a,Giovanni Grimaldi^a,Giuseppe Quarto^a,Luigi Castaldo^a,Sabrina Rossetti^a,Savio Domenico Pandolfo^c,Sonia Desicato^a,Paola Del Prete^d,Matteo Ferro^e,Sandro Pignata^f,Sisto Perdonà^a,*(

)

^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

Abstract
Related Citation (3)

Download:

HTML

PDF (460KB)
Export: BibTeX | EndNote (RIS)

Abstract

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.

Key words： Testis tumor Robot-assisted retroperitoneal lymph node dissection Retroperitoneal lymph node dissection Non-seminomatous germ cell tumor Unilateral dissection Modified template Post-chemotherapy

Received: 28 February 2023 Available online: 20 October 2023

Corresponding Authors: *E-mail address: s.perdona@istitutotumori.na.it (S. Perdonà).

	Service
	E-mail this article
	Add to citation manager
	E-mail Alert
	Articles by authors
	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

TRENDMD:

Cite this article:

Dario Franzese,Antonio Tufano,Alessandro Izzo, et al. Unilateral post-chemotherapy robot-assisted retroperitoneal lymph node dissection in Stage II non-seminomatous germ cell tumor: A tertiary care experience[J]. Asian Journal of Urology, 2023, 10(4): 440-445.

URL:

http://www.ajurology.com/EN/10.1016/j.ajur.2023.05.002 OR http://www.ajurology.com/EN/Y2023/V10/I4/440

[1]	Heidenreich A, Pfister D. Retroperitoneal lymphadenectomy and resection for testicular cancer: an update on best practice. Ther Adv Urol 2012; 4:187-205. doi: 10.1177/1756287212443170
[2]	Sheinfeld J. The role of adjunctive postchemotherapy surgery for nonseminomatous germ-cell tumors: current concepts and controversies. Semin Urol Oncol 2002; 20:262-71. pmid: 12489059
[3]	Williams SB, McDermott DW, Winston D, Bahnson E, Berry AM, Steele GS, et al. Morbidity of open retroperitoneal lymph node dissection for testicular cancer: contemporary perioperative data. BJU Int 2010; 105:918-21. doi: 10.1111/j.1464-410X.2009.08888.x pmid: 19747353
[4]	Subramanian VS, Nguyen CT, Stephenson AJ, Klein EA. Complications of open primary and post-chemotherapy retroperitoneal lymph node dissection for testicular cancer. Urol Oncol 2010; 28:504-9. doi: 10.1016/j.urolonc.2008.10.026 pmid: 19097812
[5]	Busch J, Magheli A, Erber B, Friedersdorff F, Hoffmann I, Kempkensteffen C, et al. Laparoscopic and open postchemotherapy retroperitoneal lymph node dissection in patients with advanced testicular cancerda single center analysis. BMC Urol 2012; 12:15. https://doi.org/10.1186/1471-2490-12-15. doi: 10.1186/1471-2490-12-15
[6]	Davol P, Sumfest J, Rukstalis D. Robotic-assisted laparoscopic retroperitoneal lymph node dissection. Urology 2006; 67:199. https://doi.org/10.1016/j.urology.2005.07.022. pmid: 16413370
[7]	Heidenreich A, Pfister D, Witthuhn R, Thüer D, Albers P. Postchemotherapy retroperitoneal lymph node dissection in advanced testicular cancer: radical or modified template resection. Eur Urol 2009; 55:217-24. doi: 10.1016/j.eururo.2008.09.027 pmid: 18926622
[8]	Large MC, Sheinfeld J, Eggener SE. Retroperitoneal lymph node dissection: reassessment of modified templates. BJU Int 2009; 104:1369-75. doi: 10.1111/j.1464-410X.2009.08861.x pmid: 19840015
[9]	European Association of Urology Internet. EAU guidelines on testicular cancer. https://uroweb.org/guidelines/testicularcancer/chapter/introduction. [Accessed 18 July 2023].
[10]	Heidenreich A, Pfister D, Witthuhn R, Thüer D, Albers P. Postchemotherapy retroperitoneal lymph node dissection in advanced testicular cancer: radical or modified template resection. Eur Urol 2009; 55:217-24. doi: 10.1016/j.eururo.2008.09.027 pmid: 18926622
[11]	Molina Saera J, Aparicio Urtasun J, Díaz Beveridge R, Palomar Abad L, Giménez Ortiz A, Ponce Lorenzo J, et al. Epidemiological pattern and time trends in testicular germ-cell tumors: a single institution 20-year experience. Clin Transl Oncol 2006; 8:588-93.
[12]	Powles TB, Bhardwa J, Shamash J, Mandalia S, Oliver T. The changing presentation of germ cell tumours of the testis between 1983 and 2002. BJU Int 2005; 95:1197-200. pmid: 15892800
[13]	Mistretta FA, de Cobelli O, Verze P, Botticelli F, Jannello L, Luzzago S, et al. A comprehensive evaluation of sexual and reproductive outcomes following robot-assisted retroperitoneal lymph node dissection for nonseminomatous germ cell tumor. Asian J Androl 2022; 24:579-83. doi: 10.4103/aja2021132 pmid: 35381697
[14]	Gerdtsson A, Thor A, Grenabo Bergdahl A, Alm?s B, H?kansson U, T?rnblom M, et al. Unilateral or bilateral retroperitoneal lymph node dissection in nonseminoma patients with postchemotherapy residual tumour? Results from RETROP, a population-based mapping study by the Swedish Norwegian Testicular Cancer Group. Eur Urol Oncol 2022;5: 235-43.
[15]	Cho JS, Kaimakliotis HZ, Cary C, Masterson TA, Beck S, Foster R. Modified retroperitoneal lymph node dissection for post-chemotherapy residual tumour: a long-term update. BJU Int 2017; 120:104-8. doi: 10.1111/bju.13844 pmid: 28296054
[16]	Kordan Y, K?seo?lu E, Esen B, ?zkan A, Kiremit MC, K?l?? M, et al. Postchemotherapy robotic retroperitoneal lymph node dissection for non-seminomatous germ cell tumors in the lateral decubitus position: oncological and functional outcomes. World J Urol 2023;41:1101-7.
[17]	Mir MC, Autorino R, Samarasekera D, Klink J, Stephenson AJ, Kaouk JH. Robot-assisted laparoscopic retroperitoneal lymph node dissection for left clinical Stage I non-seminomatous germ cell testicular cancer: focus on port placement and surgical technique. Int J Urol 2014; 21:212-4. doi: 10.1111/iju.12249 pmid: 24118455
[18]	Abdul-Muhsin H, Rocco N, Navaratnam A, Woods M, L’Esperance J, Castle E, et al. Outcomes of postchemotherapy robot-assisted retroperitoneal lymph node dissection in testicular cancer: multi-institutional study. World J Urol 2021; 39:3833-8. doi: 10.1007/s00345-021-03712-7 pmid: 33959785
[19]	Vallier C, Savoie PH, Delpero JR, Bladou F, Gravis G, Salem N, et al. External validation of the Heidenreich criteria for patient selection for unilateral or bilateral retroperitoneal lymph node dissection for post-chemotherapy residual masses of testicular cancer. World J Urol 2014; 32:1573-8. doi: 10.1007/s00345-014-1240-6 pmid: 24442607
[20]	Carver BS, Shayegan B, Serio A, Motzer RJ, Bosl GJ, Sheinfeld J. Long-term clinical outcome after postchemotherapy retroperitoneal lymph node dissection in men with residual teratoma. J Clin Oncol 2007; 25:1033-7. pmid: 17261854
[21]	Boukettaya W, Hochlaf M, Boudagga Z, Ezzairi F, Chabchoub I, Gharbi O, et al. Growing teratoma syndrome after treatment of a nonseminomatous germ cell tumor: a case report and a review of literature. Urol Case Rep 2013; 2:1-3.
[22]	Gorbatiy V, Spiess PE, Pisters LL. The growing teratoma syndrome: current review of the literature. Indian J Urol 2009; 25: 186-9. doi: 10.4103/0970-1591.52910
[23]	Debono DJ, Heilman DK, Einhorn LH, Donohue JP. Decision analysis for avoiding postchemotherapy surgery in patients with disseminated nonseminomatous germ cell tumors. J Clin Oncol 1997; 15:1455-64. pmid: 9193340
[24]	Beck SD, Foster RS, Bihrle R, Ulbright T, Koch MO, Wahle GR, et al. Teratoma in the orchiectomy specimen and volume of metastasis are predictors of retroperitoneal teratoma in postchemotherapy nonseminomatous testis cancer. J Urol 2002; 168:1402-4. doi: 10.1016/S0022-5347(05)64458-8
[25]	Carver BS, Bianco Jr FJ, Shayegan B, Vickers A, Motzer RJ, Bosl GJ, et al. Predicting teratoma in the retroperitoneum in men undergoing post-chemotherapy retroperitoneal lymph node dissection. J Urol 2006; 176:100-4. doi: 10.1016/S0022-5347(06)00508-8 pmid: 16753380
[26]	Wood DP Jr, Herr HW, Heller G, Vlamis V, Sogani PC, Motzer RJ, et al. Distribution of retroperitoneal metastases after chemotherapy in patients with nonseminomatous germ cell tumors. J Urol 1992; 148:1812-6. doi: 10.1016/s0022-5347(17)37036-2 pmid: 1331547
[27]	Grenabo Bergdahl A, M?nsson M, Holmberg G, Fovaeus M. Robotic retroperitoneal lymph node dissection for testicular cancer at a national referral centre. BJUI Compass 2022; 3: 363-70. doi: 10.1002/bco2.149 pmid: 35950045
[28]	Carver BS, Cronin AM, Eggener S, Savage CJ, Motzer RJ, Bajorin D, et al. The total number of retroperitoneal lymph nodes resected impacts clinical outcome after chemotherapy for metastatic testicular cancer. Urology 2010; 75: 1431-5. doi: 10.1016/j.urology.2009.11.076 pmid: 20299079
[29]	Bochner BH, Cho D, Herr HW, Donat M, Kattan MW, Dalbagni G. Prospectively packaged lymph node dissections with radical cystectomy: evaluation of node count variability and node mapping. J Urol 2004; 172:1286-90. doi: 10.1097/01.ju.0000137817.56888.d1 pmid: 15371825
[30]	Stein JP, Penson DF, Cai J, Miranda G, Skinner EC, Dunn MA, et al. Radical cystectomy with extended lymphadenectomy: evaluating separate package versus en bloc submission for node positive bladder cancer. J Urol 2007; 177:876-81; discussion 881-2. doi: 10.1016/j.juro.2006.10.043 pmid: 17296365
[31]	Pettus JA, Carver BS, Masterson T, Stasi J, Sheinfeld J. Preservation of ejaculation in patients undergoing nerve-sparing postchemotherapy retroperitoneal lymph node dissection for metastatic testicular cancer. Urology 2009; 73:328-32. doi: 10.1016/j.urology.2008.08.501 pmid: 19022490
[32]	Gerdtsson A, H?kansson U, T?rnblom M, Jancke G, Negaard HFS, Glimelius I, et al. Surgical complications in postchemotherapy retroperitoneal lymph node dissection for nonseminoma germ cell tumour: a population-based study from the Swedish Norwegian Testicular Cancer Group. Eur Urol Oncol 2020;3:382-9.