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Contemporary Perioperative Outcomes of Robotic Retroperitoneal Lymph Node Dissection for Testicular Cancer
Zhiyu Qian, MD
1,
Kevin Zhangxu, BA2, Christopher J. Magnani, MD, MPhil, MS
1, Vincent D. Andrea, MD
1, Guilherme G. Barros, MD
3, Giuliano B. Guglielmetti, MD
3, Rafael F. Coelho, MD
3, Miguel A. Mestre, MD
4, Stephan Korn, MD
1, Hanna Zurl, MD
1, Klara Pohl, MD
1, Andrea Piccolini, MD
1, Matthew Mossanen, MD, MPH
1, Quoc-Dien Trinh, MD, MBA
5, Alexander P. Cole, MD
1, Adam S. Kibel, MD
1, Timothy N. Clinton, MD, MPH
1.
1Brigham and Women's Hospital, Boston, MA, USA,
2Harvard Medical School, Boston, MA, USA,
3Universidade de Sao Paulo, Sao Paulo, Brazil,
4University Hospital of Son Espases, Mallorca, Spain,
5University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
ABSTRACTIntroduction: Robotic retroperitoneal lymph node dissection (R-RPLND) is increasingly recognized as a treatment option for testicular cancer. This study reports contemporary perioperative outcomes from a single institution and examines national trends in R-RPLND adoption.
Methods: We retrospectively reviewed patients who underwent R-RPLND at our institution between December 2022 and November 2024, stratifying outcomes by primary and post-chemotherapy RPLND. Clinical and perioperative metrics were collected and analyzed using univariable statistical tests. National trends in R-RPLND utilization were assessed using data from the National Cancer Database (NCDB) from 2012 to 2021. Descriptive statistics were employed to summarize trends, and multivariable logistic regression was performed to evaluate factors associated with the use of R-RPLND, including any temporal trends.
Results: At our institution, 31 men underwent R-RPLND, including 9 post-chemotherapy cases. The average length of stay was 1.4 days, and the average estimated blood loss was 60.3 cc. The 30-day complication rate was 3.2%, representing one case of chylous ascites. Nationally, R-RPLND utilization increased from 2.5% in 2012 to 8.3% in 2021. Multivariable analysis showed a significant yearly increase in the likelihood of undergoing R-RPLND (OR: 1.161, 95% CI: 1.042–1.294, p=0.007). Patients with stage II and III disease were less likely to receive robotic surgery compared to those with stage I disease (OR: 0.383, 95% CI: 0.167–0.880, p=0.024 for stage II; OR: 0.231, 95% CI: 0.098–0.545, p=0.001 for stage III). No 90-day mortality was observed in either cohort.
Conclusion: R-RPLND demonstrates favorable perioperative outcomes at both the institutional and national levels, with increasing utilization over the past decade. The minimally invasive approach may reduce the morbidity of open surgery and serve as an alternative to
chemoradiation in early-stage testicular cancer in carefully selected patients. Further studies are needed to evaluate long-term oncologic outcomes and cost-effectiveness.
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