Safety and Early Oncologic Effectiveness of Primary Robotic Retroperitoneal Lymph Node Dissection for Nonseminomatous Germ Cell Testicular Cancer

Background: Primary robot-assisted retroperitoneal lymph node dissection (R-RPLND) has been studied as an alternative to open RPLND in single-institution series for patients with low-stage nonseminomatous germ cell tumors (NSGCT). Objective: To evaluate a multicenter series of primary R-RPLND for low-stage NSGCT. Design, setting, and participants: Between 2011 and 2015, 47 patients underwent primary R-RPLND at four centers for Clinical Stage (CS) I-IIA NSGCT. Surgical procedure: R-RPLND was performed using the da Vinci surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA). Outcome measurements and statistical analysis: Data were collected regarding patient demographics, primary tumor characteristics, pathologic findings, and clinical outcomes. Results and limitations: Forty-two patients (89%) were CS I and five (11%) were CS IIA. The median operative time was 235. min (interquartile range [IQR]: 214-258. min), estimated blood loss was 50. ml (IQR: 50-100. ml), node count was 26 (IQR: 18-32), and length of stay was 1 d. There were two intraoperative complications (4%), four early postoperative complications (9%), no late complications, and the rate of antegrade ejaculation was 100%. Of the eight patients (17%) with positive nodes (seven pN1and one pN2), five (62%) received adjuvant chemotherapy. The one recurrence was out of template in the pelvis after adjuvant chemotherapy (resected teratoma). The median follow-up was 16 mo and the 2-yr recurrence-free survival rate was 97% (95% confidence interval: 82-100%). Limitations include retrospective design and limited follow-up. Conclusions: Our multicenter experience supports R-RPLND as a potential option at experienced centers in select patients with low-stage NSGCT. Informal comparison to open and laparoscopic series suggests R-RPLND has an acceptably low morbidity profile, but oncologic efficacy evaluation requires further evaluation. Patient summary: We examined outcomes after robot-assisted retroperitoneal lymph node dissection for patients with low-stage nonseminomatous testicular cancer with our data suggesting the robotic approach has acceptable morbidity and early oncologic outcomes. The first multicenter experience with robot-assisted retroperitoneal lymph node dissection supports the technique as a potential management option at experienced centers in select patients with low-stage nonseminomatous germ cell tumors. Robot-assisted retroperitoneal lymph node dissection has an acceptably low morbidity profile, but oncologic efficacy evaluation requires longer follow-up.