Angerer Markus, Wülfing Christian, Andura Osama, Franke Mattis, Stelzl Daniel Robert, Dieckmann Klaus-Peter
Department of Urology, Asklepios Klinik Altona, Hamburg, 22763 Hamburg, Germany.
Department of Urology, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany.
Cancers (Basel). 2025 Apr 25;17(9):1439. doi: 10.3390/cancers17091439.
Retroperitoneal lymph node dissection (RPLND) plays a crucial role in the surgical management of testicular cancer. However, RPLND is associated with a high risk of morbidity. Currently, open RPLND (O-RPLND) is considered the gold standard for surgical treatment. The use of minimally invasive techniques has increased significantly over the last few years. This study aimed to compare the safety and oncological outcomes of open (O-RPLND) and robotic (R-RPLND) retroperitoneal lymph node dissection for testicular cancer. We retrospectively analyzed all the patients who underwent RPLND at our testicular cancer center. Standard O-RPLND was performed with the usual equipment, and R-RPLND was performed with the Da Vinci X/Xi surgical system. The pre- and perioperative parameters and the postoperative complications (Clavien-Dindo classification), anejaculation, and the relapse rate were recorded. The association between the clinicopathological variables and the complications and relapse was assessed using regression analyses. Sixty-five patients underwent RPLND during 2017-2024 due to testicular cancer (TC), with thirty-one (47.7%) receiving R-RPLND, including seventeen patients post-chemotherapy (55%). Meanwhile, 34 (52.3%) underwent O-RPLND, comprising 31 patients post-chemotherapy (91%). R-RPLND demonstrated excellent results compared to O-RPLND in terms of the operative time (OT) ( < 0.00001). The R-RPLND group had two (6.5%) high-grade (Clavien-Dindo III-V) complications, while four (11.8%) high-grade complications were noted in the O-RPLND group. R-RPLND was linked to a shorter OT ( < 0.00001). The hospital stay for R-RPLND was, on average, 2.7 days shorter. In logistic regression analysis, R-RPLND was non-inferior to O-RPLND for overall complications ( = 0.6) and low-grade Clavien-Dindo (I-II) ( = 0.2) and high-grade Clavien-Dindo (≥III) complications ( = 0.7). The median follow-up was 13 months for R-RPLND and 38 months for O-RPLND. Two relapses were observed in the R-RPLND group (6.5%), and two in the O-RPLND group (5.9%). One patient who underwent R-RPLND developed field-edge recurrence. No significant differences in the relapse and anejaculation rates were found between R-RPLND and O-RPLND ( = 0.9 and = 0.8, respectively). In conclusion, R-RPLND is a feasible procedure with a low complication rate and an acceptable oncological outcome. It has proven to be significantly shorter to O-RPLND in relation to the lengths of HS and OT. However, R-RPLND is a demanding procedure with a considerable learning curve.
腹膜后淋巴结清扫术（RPLND）在睾丸癌的外科治疗中起着关键作用。然而，RPLND与高发病风险相关。目前，开放性RPLND（O-RPLND）被认为是外科治疗的金标准。在过去几年中，微创技术的使用显著增加。本研究旨在比较开放性（O-RPLND）和机器人辅助（R-RPLND）腹膜后淋巴结清扫术治疗睾丸癌的安全性和肿瘤学结局。我们回顾性分析了在我们睾丸癌中心接受RPLND的所有患者。标准的O-RPLND使用常规设备进行，R-RPLND使用达芬奇X/Xi手术系统进行。记录术前、围手术期参数以及术后并发症（Clavien-Dindo分类）、射精功能障碍和复发率。使用回归分析评估临床病理变量与并发症和复发之间的关联。2017年至2024年期间，65例因睾丸癌（TC）接受RPLND的患者中，31例（47.7%）接受了R-RPLND，其中17例（55%）为化疗后患者。同时，34例（52.3%）接受了O-RPLND，其中31例（91%）为化疗后患者。与O-RPLND相比，R-RPLND在手术时间（OT）方面显示出优异的结果（<0.00001）。R-RPLND组有2例（6.5%）高级别（Clavien-Dindo III-V级）并发症，而O-RPLND组有4例（11.8%）高级别并发症。R-RPLND与较短的OT相关（<0.00001）。R-RPLND的平均住院时间缩短了2.7天。在逻辑回归分析中，R-RPLND在总体并发症（=0.6）、低级别Clavien-Dindo（I-II级）（=0.2）和高级别Clavien-Dindo（≥III级）并发症（=0.7）方面不劣于O-RPLND。R-RPLND的中位随访时间为13个月，O-RPLND为38个月。R-RPLND组观察到2例复发（6.5%），O-RPLND组2例（5.9%）。1例接受R-RPLND的患者发生切缘复发。R-RPLND和O-RPLND在复发率和射精功能障碍发生率方面未发现显著差异（分别为=0.9和=0.8）。总之，R-RPLND是一种可行的手术方法，并发症发生率低，肿瘤学结局可接受。在住院时间和OT长度方面，已证明R-RPLND明显短于O-RPLND。然而，R-RPLND是一种要求较高的手术，有相当长的学习曲线。
