Post-chemotherapy robot-assisted retroperitoneal lymph node dissection in non-seminomatous germ cell tumor of testis: Feasibility and outcomes of initial cases

Özet

Objective: To report our initial experience and short-term results in post-chemotherapy robot-assisted retroperitoneal lymph node dissection (RA-RPLND) for advanced testicular cancer.Material and methods: We analyzed prospectively collected data of 5 patients who underwent post-chemotherapy RA-RPLND between August 2017 and May 2018. All patients had a diagnosis of non-seminomatousgerm cell tumor (NSGCT) of testis and received three or four cycles of BEP chemotherapy for their clinicalstage IIC disease before the surgery. Perioperative parameters (operation time, estimated blood loss andintraoperative complications) and postoperative findings (change in hematocrit, duration of hospitalizationand postoperative complications) were noted. Pathological outcomes and postoperative radiological imagingin the 3rd month were investigated.Results: RA-RPLND was completed successfully in all patients, and none of them required conversion toopen surgery or early intervention. The median operation time was 309 minutes (range, 275-360), and median estimated blood loss was 180 mL (range, 150-210). One patient required postoperative transfusion of1U red blood cells. The histologic examination of the specimens revealed necrosis in 3, and mature teratomain 2 patients. The median hospitalization time after surgery was 2 days. During a median follow-up of 10months (range 7-12), there were no retroperitoneal recurrences or distant metastasis in radiological imaging.No major complication (Clavien ≥3) or death occurred. The only minor complication was transfusion of redblood cells in one patient (Clavien 2) and the overall complication rate was 20 percent.Conclusion: Post-chemotherapy RA-RPLND appears to be a feasible and oncologically safe procedure withacceptable operative morbidity. However, this technique should be applied in centers highly experienced inrobotic surgery, considering that RPLND is a surgery with fatal complications.