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

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

doi:10.1016/j.euf.2024.11.001

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

Eur Urol Focus. 2024 Nov 16:S2405-4569(24)00241-4. doi: 10.1016/j.euf.2024.11.001. Online ahead of print.

Authors

Alireza Ghoreifi¹, Farshad Sheybaee Moghaddam¹, Anirban P Mitra², Ashish Khanna³, Amitabh Singh³, Julian Chavarriaga⁴, Sol C Moon⁵, Ahmed Saeed Goolam⁶, Ryan Chuang⁷, Jordan M Rich⁸, Fady J Baky⁹, Matthew Ho¹⁰, Jacob Roberts¹¹, Inderbir S Gill¹, James R Porter⁷, Nariman Ahmadi⁶, Reza Mehrazin⁸, John P Sfakianos⁸, Soroush Rais-Bahrami¹², Aditya Bagrodia¹¹, Robert J Hamilton⁴, Scott Eggener¹⁰, Sudhir Rawal³, John F Ward¹³, Hooman Djaladat¹⁴

Affiliations

¹ Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
² Department of Urology and Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
³ Department of Uro-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India.
⁴ Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada.
⁵ Department of Urology, Heersink School of Medicine, University of Alabama, Birmingham, AL, USA.
⁶ Department of Urology, Chris O'Brien Lifehouse, Sydney, Australia.
⁷ Swedish Medical Group, Seattle, WA, USA.
⁸ Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁹ Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹⁰ Department of Surgery, Section of Urology, University of Chicago, Chicago, IL, USA.
¹¹ Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA.
¹² Department of Urology, Heersink School of Medicine, University of Alabama, Birmingham, AL, USA; Department of Radiology, Heersink School of Medicine, University of Alabama, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, Heersink School of Medicine, University of Alabama, Birmingham, AL, USA.
¹³ Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
¹⁴ Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. Electronic address: djaladat@med.usc.edu.

PMID: 39551650
DOI: 10.1016/j.euf.2024.11.001

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.

Keywords: Nonseminomatous germ cell tumor; Outcomes; Retroperitoneal lymph node dissection; Robotic surgery; Testicular neoplasms.