Nason G J, Kuhathaas K, Anson-Cartwright L, Jewett M A S, O'Malley M, Sweet J, Hansen A, Bedard P, Chung P, Hahn E, Warde P, Hamilton R J
Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, 610 University Avenue, Suite 3-130, Toronto, ON, M5G 1X5, Canada.
Division of Abdominal Imaging, Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada.
J Robot Surg. 2022 Apr;16(2):369-375. doi: 10.1007/s11701-021-01252-1. Epub 2021 May 12.
The role of retroperitoneal lymph node dissection (RPLND) in testicular cancer is well established in both the primary and post-chemotherapy setting. The aim of this study was to report our 2 years oncological outcomes of robotic RPLND. A retrospective review was performed of all patients undergoing robotic RPLND by a single surgeon at Princess Margaret Cancer Centre. Demographic, perioperative, and oncologic data were analyzed using descriptive statistics. Between September 2014 and June 2020, 141 patients underwent an RPLND [33 (23.4%) were primary, 108 (76.6%) were post-chemotherapy]. 27 (19.1%) patients underwent a robotic bilateral template nerve-sparing RPLND. RPLND indication was primary (i.e. pre-chemotherapy) in 18 (66.7%), and post-chemotherapy in 9 (33.3%) patients. Stage at RPLND was 2A (n = 15, 55.6%), 2B (n = 9, 33.3%), 2C (n = 1, 3.7%) and 3 (n = 2, 7.4%). Median OR time (incision to closure) was 525 min and blood loss was 200 ml. Nerve sparing was performed in all but one case. Six (22.2%) adjuvant procedures were performed including two (7.4%) vascular repairs. Median length of stay was 2 days. Viable tumor was detected in 17 (63%) and teratoma in 9 (33.3%). Median follow-up was 31.3 months. No adjuvant chemotherapy was given. Three patients (11.1%) relapsed: 2 out-of-field and 1 with both in-field and out-of-field disease. Robotic RPLND can be performed safely. Long-term follow-up of series such as ours, enriched with patients with viable disease and/or teratoma, and not treated with adjuvant chemotherapy is required to ensure oncological outcomes are comparable to the open approach.
腹膜后淋巴结清扫术（RPLND）在睾丸癌的初始治疗及化疗后治疗中的作用已得到充分确立。本研究的目的是报告我们开展机器人辅助RPLND的2年肿瘤学治疗结果。对玛格丽特公主癌症中心的一位外科医生实施机器人辅助RPLND的所有患者进行了回顾性分析。使用描述性统计方法分析人口统计学、围手术期及肿瘤学数据。在2014年9月至2020年6月期间，141例患者接受了RPLND[33例（23.4%）为初始治疗，108例（76.6%）为化疗后治疗]。27例（19.1%）患者接受了机器人辅助双侧保留神经模板式RPLND。RPLND的适应证为初始治疗（即化疗前）的有18例（66.7%），化疗后的有9例（33.3%）。RPLND时的分期为2A期（n = 15，55.6%）、2B期（n = 9，33.3%）、2C期（n = 1，3.7%）和3期（n = 2，7.4%）。中位手术时间（切开至缝合）为525分钟，失血量为200毫升。除1例患者外均实施了保留神经手术。实施了6例（22.2%）辅助手术，包括2例（7.4%）血管修复。中位住院时间为2天。发现17例（63%）有存活肿瘤，9例（33.3%）有畸胎瘤。中位随访时间为31.3个月。未给予辅助化疗。3例患者（11.1%）复发：2例为野外复发，1例为野内和野外均有病变。机器人辅助RPLND可以安全实施。需要对我们这样的系列进行长期随访，纳入有存活肿瘤和/或畸胎瘤且未接受辅助化疗的患者，以确保肿瘤学治疗结果与开放手术相当。
