Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
Department of Oncology, Indiana University School of Medicine, Indianapolis, IN, USA.
Eur Urol. 2019 Nov;76(5):607-609. doi: 10.1016/j.eururo.2019.05.031. Epub 2019 Jun 4.
Surgery for metastatic testicular disease has been an essential factor in the long-term cure rates for men with testicular germ cell tumors. Robotic approaches to retroperitoneal lymph node dissection (R-RPLND) have been proposed as an alternative to open surgery with few if any adverse events reported. We report the clinical course for five recent patients referred to our center for recurrences after R-RPLND, focusing on recurrence patterns, treatment burden, and treatment-related morbidity and mortality. The median time to recurrence after R-RPLND was 259d. The recurrence patterns after R-RPLND were aberrant from our past experience in managing recurrences after open RPLND. One man experienced an in-field recurrence located in close proximitry to an undivided lumbar vessel. Four patients had out-of-field recurrence in abnormal locations: pericolic space invading the sigmoid colon, peritoneal carcinomatosis with a perinephric mass, large-volume liver lesions with suprahilar disease extending into the retrocrural space, and lymph nodes in the celiac axis. The treatment burden was high: the five men were subjected to 12 different chemotherapy regimens and three underwent additional surgeries. Three patients developed significant cisplatin-induced toxicity. One patient died due to progression of testicular cancer after failing all chemotherapy and surgical options. PATIENT SUMMARY: We report our initial experience in managing patients with testicular cancer referred to our institution after robotic retroperitoneal lymph node dissection (RPLND). We found that the recurrences were highly variable and in unusual locations and were associated with a high treatment burden. We conclude that further investigation into the safety and long-term oncologic efficacy of robotic RPLND is necessary before widespread implementation.
手术治疗转移性睾丸疾病是提高睾丸生殖细胞肿瘤患者长期治愈率的重要因素。机器人辅助腹膜后淋巴结清扫术（R-RPLND）已被提议作为开放手术的替代方法，其报道的不良事件很少。我们报告了最近转诊至我们中心的 5 例 R-RPLND 后复发患者的临床经过，重点关注复发模式、治疗负担以及与治疗相关的发病率和死亡率。R-RPLND 后复发的中位时间为 259d。R-RPLND 后复发的模式与我们过去管理开放 RPLND 后复发的经验不同。1 名患者出现了局部复发，位于未分开的腰血管附近。4 名患者出现了远处复发，位置异常：结肠旁间隙侵犯乙状结肠、腹膜转移伴肾周肿块、肝大病变伴肝门上方疾病扩展至肾后间隙、腹腔干淋巴结。治疗负担很高：这 5 名患者接受了 12 种不同的化疗方案，3 名患者接受了额外的手术。3 名患者出现了严重的顺铂诱导毒性。1 名患者在所有化疗和手术选择失败后死于睾丸癌进展。患者总结：我们报告了我们在机构中管理接受机器人腹膜后淋巴结清扫术（RPLND）后转诊的睾丸癌患者的初步经验。我们发现复发模式高度多变且位置异常，与高治疗负担相关。我们得出结论，在广泛实施之前，需要进一步研究机器人 RPLND 的安全性和长期肿瘤学疗效。
