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Introduction:
Retroperitoneal lymph node dissection (RPLND) remains a management option for early-stage non-seminomatous germ cell tumors (NSGCT). Robotic RPLND offers a minimally-invasive strategy for the surgical management of this disease.
Materials & Methods:
Between 2008-2014, 56 patients underwent primary R-RPLND at four centers for CS I-IIA NSGCT. Patient demographics, primary tumor characteristics, perioperative information, pathologic findings, and clinical outcomes were evaluated.
Results:
48 (89%) patients were CS I and 8 (11%) were CS IIA. Median operative time was 239 minutes (IQR: 219-271 min), estimated blood loss was 50 mL (IQR: 50-100 mL), node count was 24 (IQR: 18-31), and median length of stay was 1 day. There were 2 intraoperative complications (4%) including 1 open conversion (2%), and 5 early post-operative complications (9%). No late complications were observed and the rate of antegrade ejaculation was 96%. Of the 11 patients (20%) with positive nodes (9 pN1and 2 pN2), 6 (55%) received adjuvant chemotherapy. There was 1 out-of template recurrence (2%) which was resected (teratoma). There have been no retroperitoneal or systemic recurrences. At a median follow-up of 15 months, the overall recurrence-free rate was 98%, including a 100% recurrence-free rate among patients with pN+ disease without adjuvant chemotherapy (n=5) at a median of 33 months follow-up.
Conclusions:
Our early multicenter experience supports R-RPLND as a potential management option at experienced centers in select patients with low-stage NSGCT. R-RPLND has an acceptably low morbidity profile, but oncologic efficacy evaluation requires longer follow-up and observation of low-volume pathologic stage II patients.