Minimally invasive retroperitoneal lymph node dissection for men with testis cancer: a retrospective cohort study of safety and feasibility

Christian D. Fankhauser, Luca Afferi, Sean P. Stroup, Nicholas R. Rocco, Kathleen Olson, Aditya Bagrodia, Fady Baky, Walter Cazzaniga, Erik Mayer, David Nicol, Ekrem Islamoglu, Stephane de Vergie, Ragheed Saoud, Scott E. Eggener, Sebastiano Nazzani, Nicola Nicolai, Lee Hugar, Wade J. Sexton, Deliu Victor Matei, Ottavio De CobelliJoseph Cheaib, Phillip M. Pierorazio, James Porter, Thomas Hermanns, Robert J. Hamilton, Andreas Hiester, Peter Albers, Noel Clarke, Agostino Mattei

Research output: Contribution to journalArticlepeer-review


Purpose: To describe the perioperative safety, functional and immediate post-operative oncological outcomes of minimally invasive RPLND (miRPLND) for testis cancer. Methods: We performed a retrospective multi-centre cohort study on testis cancer patients treated with miRPLND from 16 institutions in eight countries. We measured clinician-reported outcomes stratified by indication. We performed logistic regression to identify predictors for maintained postoperative ejaculatory function. Results: Data for 457 men undergoing miRPLND were studied. miRPLND comprised laparoscopic (n = 56) or robotic (n = 401) miRPLND. Indications included pre-chemotherapy in 305 and post-chemotherapy in 152 men. The median retroperitoneal mass size was 32 mm and operative time 270 min. Intraoperative complications occurred in 20 (4%) and postoperative complications in 26 (6%). In multivariable regression, nerve sparing, and template resection improved ejaculatory function significantly (template vs bilateral resection [odds ratio (OR) 19.4, 95% confidence interval (CI) 6.5–75.6], nerve sparing vs non-nerve sparing [OR 5.9, 95% CI 2.3–16.1]). In 91 men treated with primary RPLND, nerve sparing and template resection, normal postoperative ejaculation was reported in 96%. During a median follow-up of 33 months, relapse was detected in 39 (9%) of which one with port site (< 1%), one with peritoneal recurrence and 10 (2%) with retroperitoneum recurrences. Conclusion: The low proportion of complications or peritoneal recurrences and high proportion of men with normal postoperative ejaculatory function supports further miRPLND studies.

Original languageEnglish (US)
Pages (from-to)1505-1512
Number of pages8
JournalWorld journal of urology
Issue number6
StatePublished - Jun 2022


  • Germ cell tumours
  • Retroperitoneal lymph node dissection
  • Robotic surgery
  • Testis cancer

ASJC Scopus subject areas

  • Urology


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