Pongratanakul Pailin, Vermeulen-Spohn Marieke, Wöltjen Carolin, Thy Sophia, Hiester Andreas, Albers Peter, Che Yue
Department of Urology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
BJU Int. 2025 Jul;136(1):150-158. doi: 10.1111/bju.16747. Epub 2025 Apr 22.
To analyse a comparatively large cohort of patients who underwent robot-assisted retroperitoneal lymph node dissection (R-RPLND) in a single centre, assessing the peri-operative and oncological safety of this procedure compared to that in a matched-pair cohort of patients who underwent open retroperitoneal lymph node dissection (O-RPLND).
We retrospectively identified 100 patients who underwent R-RPLND between October 2010 and January 2024. A matched-pair analysis of R-RPLNDs and O-RPLNDs was conducted based on the following criteria: surgical indication, histology, clinical stage (CS), and tumour size. The primary endpoint of this analysis was progression-free survival (PFS). Secondary endpoints were peri-operative parameters.
Based on surgical indication, the R-RPLND cohort was divided into four groups: CS II seminoma (Group 1, 42 patients); marker-negative CS II non-seminoma (Group 2, 15 patients); CS I non-seminoma with high-risk factors (Group 3, seven patients), and post-chemotherapy patients (Group 4, 34 patients). Two patients were excluded due to uncommon testicular histology. With a mean follow-up of 32, 31, 32 and 28 months in the four groups, respectively, relapses occurred in 10/42 of Group 1, 3/15 of Group 2, and 1/7 of Group 3, while all patients remained relapse-free in Group 4. The matched-pair analysis revealed that histological retroperitoneal lymph node dissection specimens, relapse rates, and PFS were similar in the R-RPLND and O-RPLND groups. R-RPLND had advantages in terms of a shorter hospital stay as a surrogate for less morbidity.
In selected patients and selected surgical indications, R-RPLND represents a minimally invasive alternative to O-RPLND in the management of patients with testicular germ cell tumours.
分析在单一中心接受机器人辅助腹膜后淋巴结清扫术（R-RPLND）的相对较大队列患者，与接受开放腹膜后淋巴结清扫术（O-RPLND）的配对队列患者相比，评估该手术的围手术期和肿瘤学安全性。
我们回顾性确定了2010年10月至2024年1月期间接受R-RPLND的100例患者。基于以下标准对R-RPLND和O-RPLND进行配对分析：手术指征、组织学、临床分期（CS）和肿瘤大小。该分析的主要终点是无进展生存期（PFS）。次要终点是围手术期参数。
根据手术指征，R-RPLND队列分为四组：CS II期精原细胞瘤（第1组，42例患者）；标志物阴性的CS II期非精原细胞瘤（第2组，15例患者）；具有高危因素的CS I期非精原细胞瘤（第3组，7例患者）和化疗后患者（第4组，34例患者）。2例患者因罕见的睾丸组织学而被排除。四组的平均随访时间分别为32、31、32和28个月，第1组42例中有10例复发，第2组15例中有3例复发，第3组7例中有1例复发，而第4组所有患者均无复发。配对分析显示，R-RPLND组和O-RPLND组的组织学腹膜后淋巴结清扫标本、复发率和PFS相似。R-RPLND在缩短住院时间方面具有优势，可作为发病率较低的替代指标。
在选定的患者和选定的手术指征中，R-RPLND是睾丸生殖细胞肿瘤患者管理中O-RPLND的微创替代方案。
