Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, People's Republic of China.
Department of Urology, Zhejiang Provincial Hospital of Chinese Medicine, Zhejiang Chinese Medical University, Hangzhou, 310000, Zhejiang, People's Republic of China.
World J Urol. 2023 Jul;41(7):1877-1883. doi: 10.1007/s00345-023-04459-z. Epub 2023 Jun 19.
To compare the perioperative outcomes of L-RPLND, R-RPLND and O-RPLND, and determine which one can be the mainstream option.
We retrospectively reviewed medical records of 47 patients undergoing primary RPLND by three different surgical techniques for stage I-II NSGCT between July 2011 and April 2022 at our center. Standard open and laparoscopic RPLND was performed with usual equipment, and robotic RPLND was operated with da Vinci Si system.
Forty-seven patients underwent RPLND during 2011-2022, and 26 (55.3%) of them received L-RPLND, 14 (29.8%) were operated with robot, while 7 (14.9%) were performed O-RPLND. The median follow-up was 48.0 months, 48.0 months, and 60.0 months, respectively. The oncological outcomes were comparable among all groups. In L-RPLND group, there were 8 (30.8%) cases of low grade (Clavien I-II) complications, and 3 (11.5%) cases of high-grade (Clavien III-IV) complications. In R-RPLND group, one (7.1%) low-grade complication and four (28.6%) high-grade complications were observed. In O-RPLND group, there were 2 (28.5%) cases of low-grade complications and one case (14.2%) of high-grade one. The operation duration of L-RPLND was the shortest. In O-RPLND group, the number of positive lymph nodes were higher than other two groups. Patients undergoing open surgery had lower (p < 0.05) red blood cell count, hemoglobin level, and higher (p < 0.05) estimated blood loss, white blood cell count than those receiving either laparoscopic or robotic surgery.
All three surgical techniques are comparable in safety, oncological, andrological, and reproductive outcomes under the circumstance of not using primary chemotherapy. L-RPLND might be the most cost-effective option.
比较腹腔镜经腹膜后淋巴结清扫术（L-RPLND）、机器人辅助经腹膜后淋巴结清扫术（R-RPLND）和开放经腹膜后淋巴结清扫术（O-RPLND）的围手术期结果，并确定哪种方法可以成为主流选择。
我们回顾性分析了 2011 年 7 月至 2022 年 4 月期间在我院接受三种不同手术方式治疗 I-II 期非精原细胞瘤生殖细胞肿瘤（NSGCT）的 47 例患者的病历资料。标准开放和腹腔镜 RPLND 使用常规设备进行，机器人 RPLND 使用达芬奇 Si 系统进行。
2011 年至 2022 年期间，47 例患者接受了 RPLND，其中 26 例（55.3%）接受了 L-RPLND，14 例（29.8%）接受了机器人辅助手术，7 例（14.9%）接受了 O-RPLND。中位随访时间分别为 48.0 个月、48.0 个月和 60.0 个月。所有组的肿瘤学结果均相似。在 L-RPLND 组中，有 8 例（30.8%）发生低级别（Clavien I-II）并发症，3 例（11.5%）发生高级别（Clavien III-IV）并发症。在 R-RPLND 组中，观察到 1 例（7.1%）低级别并发症和 4 例（28.6%）高级别并发症。在 O-RPLND 组中，有 2 例（28.5%）发生低级别并发症，1 例（14.2%）发生高级别并发症。L-RPLND 的手术时间最短。在 O-RPLND 组中，阳性淋巴结数量高于其他两组。接受开放手术的患者的红细胞计数、血红蛋白水平较低（p<0.05），而白细胞计数较高（p<0.05）。
在不使用初始化疗的情况下，三种手术技术在安全性、肿瘤学、男科和生殖结果方面具有可比性。L-RPLND 可能是最具成本效益的选择。
