Robotic Retroperitoneal Lymph Node Dissection in Chemotherapy Residual Mass in Testicular Cancer – Combined Supine and Lateral Approach: Initial Experience from a Tertiary Centre.

Retroperitoneal lymph node dissection (RPLND) remains a standard of care option in the management of early-stage testicular cancer in the setting of post-chemotherapy non-seminomatous germ cell tumors (NSGCT) with residual retroperitoneal mass. As robotic expertise in complex surgery improves, more teams have adopted this approach, which offers the promise of lower morbidity compared to a standard, open approach via a midline incision. We present our initial experience with robotic RPLND (R-RPLND) for testicular cancer.

Six patients (age 27–38) with NSGCT of the testis underwent R-RPLND for post-chemotherapy residual retroperitoneal masses with normalized tumor markers for clinically stage IIA NSGCT. Data were collected regarding patient demography, tumor characteristics, and surgical, pathological, and oncological outcomes. All patients had a diagnosis of NSGCT of the testis and three or four cycles of BEP chemotherapy before surgery. Perioperative parameters (operation time, estimated blood loss, and intraoperative complications) and postoperative findings (duration of hospitalization and postoperative complications) were noted.

Mean console time and estimated blood loss were 240 (60–490) minutes and 310 (40–600) ml, respectively. The mean lymph node yield was 21 (10–35). The median hospital stay was 4 days. Two patients had postoperative complications; All patients were advanced to a normal diet on postoperative day 1. Histopathology reports were suggestive of metastatic mature teratoma in four patients, and two patients had no viable tumor. There have been no systemic or retroperitoneal recurrences in these patients at a mean follow-up of 16 months (12–24 months).

Robotic RPLND is safe and feasible in post-chemotherapy settings for properly selected patients, with shorter recovery times compared to the open approach. Early experience indicates a low rate of perioperative complications and excellent oncologic outcomes. R-RPLND is linked to low blood loss and brief hospital stays. More research is necessary to evaluate long-term results and compare them to standard open RPLND.