Oncological Outcomes Following Robotic Postchemotherapy Retroperitoneal Lymph Node Dissection for Testicular Cancer: A Worldwide Multicenter Study.

IF 4.8 2区 医学 Q1 UROLOGY & NEPHROLOGY European urology focus Pub Date : 2024-11-16 DOI:10.1016/j.euf.2024.11.001
Alireza Ghoreifi, Farshad Sheybaee Moghaddam, Anirban P Mitra, Ashish Khanna, Amitabh Singh, Julian Chavarriaga, Sol C Moon, Ahmed Saeed Goolam, Ryan Chuang, Jordan M Rich, Fady J Baky, Matthew Ho, Jacob Roberts, Inderbir S Gill, James R Porter, Nariman Ahmadi, Reza Mehrazin, John P Sfakianos, Soroush Rais-Bahrami, Aditya Bagrodia, Robert J Hamilton, Scott Eggener, Sudhir Rawal, John F Ward, Hooman Djaladat
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Abstract

Background and objective: The feasibility and safety of a robotic approach for postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) in testicular cancer have been demonstrated, but data on long-term oncological outcomes of this procedure are limited. Our aim was to evaluate oncological outcomes following robotic PC-RPLND in this setting.

Methods: This retrospective cohort study included consecutive patients with testicular cancer treated with robotic PC-RPLND at 11 academic centers worldwide between 2011 and 2023. Patient characteristics, clinicopathological findings, and oncological outcomes were recorded. Recurrence-free survival (RFS) was estimated via the Kaplan-Meier method.

Key findings and limitations: A total of 173 patients were included, of whom 159 underwent pure robotic PC-RPLND; 14 cases were converted to open surgery. Among the pure robotic cases, 152 (96%) had nonseminoma, 122 (77%) had International Germ Cell Cancer Collaborative Group good risk, and 120 (76%) had a postchemotherapy mass size ≤5 cm. Salvage chemotherapy was received by ten patients (6%). Median estimated blood loss, operative time, and length of hospital stay were 100 ml, 300 min, and 2 d, respectively. Final pathology revealed necrosis/fibrosis in 64 cases (40%), teratoma in 78 (49%), and viable germ-cell tumor in 17 (11%). At median follow-up of 22 mo (interquartile range 7-50), eight patients had disease recurrence, which was in-field in three cases. One port-site recurrence was identified. The median time to recurrence was 7 mo. The 4-yr RFS rate was 93%. Two cancer-related deaths were recorded. Subgroup analysis revealed that patients with conversion to open surgery were more likely to have a larger preoperative mass and received salvage chemotherapy before RPLND. In addition, conversion to open surgery was associated with a higher rate of perioperative complications; however, oncological outcomes were statistically similar to those for pure robotic PC-RPLND. The main limitation of the study is its retrospective nature.

Conclusions and clinical implications: Robotic PC-RPLND in testicular cancer is associated with acceptable intermediate-term oncological outcomes in appropriately selected patients.

Patient summary: In this large multicenter study, we investigated the outcomes of robotic surgery after chemotherapy for advanced testicular cancer. We found that robotic surgery yields acceptable cancer control results.

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睾丸癌机器人化疗后腹膜后淋巴结清扫术的肿瘤学结果:一项全球多中心研究。
背景和目的:睾丸癌化疗后腹膜后淋巴结清扫术(PC-RPLND)的机器人方法的可行性和安全性已得到证实,但该手术的长期肿瘤学结果数据有限。我们的目的是评估机器人PC-RPLND术后的肿瘤治疗效果:这项回顾性队列研究纳入了 2011 年至 2023 年间在全球 11 个学术中心接受机器人 PC-RPLND 治疗的连续睾丸癌患者。研究记录了患者特征、临床病理结果和肿瘤结局。无复发生存期(RFS)通过卡普兰-梅耶法估算:共纳入173例患者,其中159例接受了纯机器人PC-RPLND手术,14例转为开放手术。在纯机器人手术病例中,152例(96%)为非良性肿瘤,122例(77%)为国际生殖细胞癌协作组高危病例,120例(76%)化疗后肿块大小≤5厘米。10名患者(6%)接受了挽救性化疗。估计失血量、手术时间和住院时间的中位数分别为100毫升、300分钟和2天。最终病理结果显示:坏死/纤维化 64 例(40%),畸胎瘤 78 例(49%),存活生殖细胞瘤 17 例(11%)。中位随访 22 个月(四分位间范围 7-50),8 例患者疾病复发,其中 3 例为现场复发。此外,还发现 1 例端口部位复发。中位复发时间为 7 个月,4 年 RFS 率为 93%。有两例癌症相关死亡记录。亚组分析显示,转为开放手术的患者术前肿块更大且在RPLND前接受过挽救性化疗的可能性更大。此外,转为开放手术与围手术期并发症发生率较高有关;不过,从统计学角度来看,肿瘤结果与纯机器人 PC-RPLND 的结果相似。该研究的主要局限性在于其回顾性:患者总结:在这项大型多中心研究中,我们调查了晚期睾丸癌化疗后机器人手术的疗效。我们发现,机器人手术能产生可接受的癌症控制效果。
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来源期刊
European urology focus
European urology focus Medicine-Urology
CiteScore
10.40
自引率
3.70%
发文量
274
审稿时长
23 days
期刊介绍: European Urology Focus is a new sister journal to European Urology and an official publication of the European Association of Urology (EAU). EU Focus will publish original articles, opinion piece editorials and topical reviews on a wide range of urological issues such as oncology, functional urology, reconstructive urology, laparoscopy, robotic surgery, endourology, female urology, andrology, paediatric urology and sexual medicine. The editorial team welcome basic and translational research articles in the field of urological diseases. Authors may be solicited by the Editor directly. All submitted manuscripts will be peer-reviewed by a panel of experts before being considered for publication.
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