Department of Urology, University of Texas Health, San Antonio, TX, USA.
Department of Urology, University of Washington, Seattle, WA, USA.
BJU Int. 2023 Jul;132(1):9-30. doi: 10.1111/bju.15986. Epub 2023 Mar 9.
To assess the safety and feasibility of robot-assisted retroperitoneal lymph node dissection (R-RPLND) and to compare the perioperative outcomes of R-RPLND with open RPLND (O-RPLND), as RPLND forms an integral part of the management of testis cancer and R-RPLND is a minimally invasive treatment option for this disease.
The PubMed , Scopus , Cochrane Central Register of Controlled Trials, and Web of Science™ databases were searched for studies reporting perioperative outcomes of primary and post-chemotherapy R-RPLND and studies comparing R-RPLND with O-RPLND.
The search yielded 42 articles describing R-RPLND, including five comparative studies. The systematic review included 4222 patients (single-arm studies, n = 459; comparative studies, n = 3763). Of 459 patients in the single-arm studies, 271 underwent primary R-RPLND and 188 underwent post-chemotherapy R-RPLND. For primary R-RPLND, the operative time ranged from 175 to 540 min and the major complication rate was 4.1%. For post-chemotherapy R-RPLND, the operative time ranged from 134 to 550 min and the major complication rate was 8.5%. The conversion rate to open surgery was 2.2% in primary R-RPLND and 9.0% in post-chemotherapy R-RPLND. In comparison with O-RPLND, R-RPLND was associated with a lower transfusion rate (14.5% vs 0.9%, P < 0.001) and a lower complication rate (18.5% vs 7.8%, P = 0.002).
Robot-assisted RPLND has acceptable perioperative outcomes in both the primary and post-chemotherapy settings but a notable rate of conversion to open surgery in the post-chemotherapy setting. Compared with O-RPLND, R-RPLND is associated with a lower transfusion rate and fewer overall complications. Given the potential impact of selection bias, the optimal patient selection criteria for R-RPLND remain to be elucidated.
评估机器人辅助腹膜后淋巴结清扫术（R-RPLND）的安全性和可行性，并比较 R-RPLND 与开放 RPLND（O-RPLND）的围手术期结果，因为 RPLND 是睾丸癌治疗的重要组成部分，而 R-RPLND 是该疾病的一种微创治疗选择。
检索 PubMed、Scopus、Cochrane 对照试验中心注册库和 Web of Science™ 数据库，以获取报告原发性和化疗后 R-RPLND 围手术期结果的研究以及比较 R-RPLND 与 O-RPLND 的研究。
检索结果得到 42 篇描述 R-RPLND 的文章，其中包括 5 项比较研究。系统综述纳入了 4222 例患者（单臂研究 n=459；比较研究 n=3763）。在单臂研究中，459 例患者中有 271 例行原发性 R-RPLND，188 例行化疗后 R-RPLND。对于原发性 R-RPLND，手术时间范围为 175-540 分钟，主要并发症发生率为 4.1%。对于化疗后 R-RPLND，手术时间范围为 134-550 分钟，主要并发症发生率为 8.5%。原发性 R-RPLND 中转开腹手术的转化率为 2.2%，化疗后 R-RPLND 中转开腹手术的转化率为 9.0%。与 O-RPLND 相比，R-RPLND 的输血率较低（14.5%比 0.9%，P<0.001），并发症发生率也较低（18.5%比 7.8%，P=0.002）。
机器人辅助 RPLND 在原发性和化疗后环境中具有可接受的围手术期结果，但在化疗后环境中转开腹手术的比例较高。与 O-RPLND 相比，R-RPLND 的输血率较低，总并发症较少。鉴于选择偏倚的潜在影响，R-RPLND 的最佳患者选择标准仍有待阐明。
