Department of Urology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA, 92134, USA.
Department of Urology, Mayo Clinic, Phoenix, AZ, USA.
World J Urol. 2020 Apr;38(4):859-867. doi: 10.1007/s00345-019-02900-w. Epub 2019 Sep 9.
To evaluate the intermediate-term oncologic outcomes and safety profile of the largest case series of primary robotic retroperitoneal lymphadenectomy for low-clinical-stage non-seminomatous germ cell testicular cancer.
This was a two-center retrospective analysis of robotic RPLND cases for low-clinical-stage (stage I-IIB) non-seminomatous germ cell testicular cancer in the primary setting. Demographic, perioperative, operative and oncologic variables were collected between March 2008 and May 2019. Descriptive analyses were performed and presented as medians with interquartile ranges for continuous variables and frequency and proportions for categorical variables. A survival analysis of time to recurrence was performed using Cox proportional hazards model. Using logistic regression, risk factors for complications were analyzed. Both univariate and multivariate analyses were performed.
A total of 58 patients (CS 1 = 56, CS IIA = 2, CS IIB = 0) were identified. The median follow-up was 47 months and the 2-year recurrence-free survival rate was 91%. The five recurrences were all out of the performed dissection template (pelvis = 1 and lung = 4). Only five patients (29%) with occult metastasis underwent adjuvant chemotherapy. The median operative time was 319 min [interquartile range (IQR) 276-355 min], estimated blood loss was 100 ml (IQR 75-200 ml), node count was 26 (IQR 20-31), and length of stay 2 d (IQR 1-3 days). There were 2 (3.3%) intraoperative complications, 19 (32.7%) 30-day postoperative complications to include 14 (24.1%) Clavien grade I, 4 (6.9%) Clavien grade II, 1 (1.7%) Clavien grade III and 0 Clavien grade IV complications. No statistical significance was found on multivariate or univariate analysis for survival analysis of time to recurrence and risk factors for complications.
This study represents the largest case series of primary R-RPLND for the treatment of low-stage non-seminomatous germ cell tumors (NSGCT). With 47 months of follow-up and a low rate of adjuvant chemotherapy, intermediate oncologic efficacy appears to be comparable to the gold standard open approach.
评估原发性机器人后腹膜淋巴结清扫术治疗低临床分期非精原细胞瘤生殖细胞睾丸癌的最大病例系列的中期肿瘤学结果和安全性概况。
这是一项对 2008 年 3 月至 2019 年 5 月在原发性低临床分期（I-IIB 期）非精原细胞瘤生殖细胞睾丸癌患者中进行的机器人后腹膜淋巴结清扫术（RPLND）病例的回顾性分析。收集了人口统计学、围手术期、手术和肿瘤学变量。采用描述性分析，连续变量采用中位数和四分位数范围表示，分类变量采用频率和比例表示。使用 Cox 比例风险模型对复发时间进行生存分析。采用逻辑回归分析并发症的危险因素。同时进行单因素和多因素分析。
共纳入 58 例患者（CS1=56 例，CS IIA=2 例，CS IIB=0 例）。中位随访时间为 47 个月，2 年无复发生存率为 91%。5 例复发均发生在已行清扫的模板外（骨盆 1 例，肺 4 例）。仅 5 例（29%）隐匿性转移患者接受了辅助化疗。中位手术时间为 319 分钟[四分位距（IQR）276-355 分钟]，估计失血量为 100 毫升（IQR 75-200 毫升），淋巴结计数为 26（IQR 20-31），住院时间为 2 天（IQR 1-3 天）。有 2 例（3.3%）术中并发症，19 例（32.7%）30 天术后并发症，包括 14 例（24.1%）Clavien I 级，4 例（6.9%）Clavien II 级，1 例（1.7%）Clavien III 级和 0 例 Clavien IV 级并发症。多因素和单因素分析均未发现与复发时间的生存分析和并发症风险因素相关的统计学意义。
本研究代表了治疗低分期非精原细胞瘤生殖细胞瘤（NSGCT）的最大原发性 R-RPLND 病例系列。在 47 个月的随访和低辅助化疗率下，中期肿瘤学疗效似乎与金标准的开放方法相当。
