Angerer Markus, Wülfing Christian, Dieckmann Klaus-Peter
Department of Urology, Asklepios Klinik Altona, Paul-Ehrlich-Strasse 1, 22763 Hamburg, Germany.
Cancers (Basel). 2025 Apr 27;17(9):1476. doi: 10.3390/cancers17091476.
Retroperitoneal lymph node dissection (RPLND) plays a crucial role in the staging and treatment of testicular cancer and is often mandatory. RPLND is associated with a high risk of morbidity. The use of minimally invasive techniques has significantly increased the number of robotic procedures performed over the last few years. This study aimed to analyze the perioperative and postoperative outcomes and trends of an increasing number of surgeries performed. We retrospectively analyzed 30 robotic RPLNDs (R-RPLNDs) performed at our testicular cancer center between 2020 and 2024. Logistic regression analyses were used to analyze the independent variables of operative time (OT), hospital stay (HS), estimated blood loss, lymph node yield, and complications according to the Clavien-Dindo classification system. The independent predictors included case number, clinical stage, post-chemotherapy status, preoperative retroperitoneal tumor mass, and body mass index. Furthermore, the patients were categorized into three groups: group A (cases 1-10), group B (cases 11-20), and group C (cases 21-30). A Kruskal-Wallis test was performed to assess differences among the groups concerning OT, HS, and lymph node yield. OT significantly decreased with an increasing number of cases ( < 0.001), and HS was significantly affected by overall complications ( = 0.0006). There were two major perioperative complications (6.6%). No factors predicted overall complications or Clavien-Dindo grades I-II or III-V. The Kruskal-Wallis test showed a significant difference ( < 0.05) in OT and HS for group C. R-RPLND for GCTs demonstrates a clear learning curve, with significant improvements in OT, HS, and complication rates as surgeons gain experience. Overall, the low complication rates for R-RPLND did not indicate predictive factors for perioperative or postoperative complications. RPLND presents promising potential as a safe and effective treatment for GCTs, especially when performed by experienced surgeons in specialized centers.
腹膜后淋巴结清扫术（RPLND）在睾丸癌的分期和治疗中起着关键作用，通常是必需的。RPLND与高发病风险相关。在过去几年中，微创技术的应用显著增加了机器人手术的数量。本研究旨在分析越来越多手术的围手术期和术后结果及趋势。我们回顾性分析了2020年至2024年在我们的睾丸癌中心进行的30例机器人腹膜后淋巴结清扫术（R-RPLND）。根据Clavien-Dindo分类系统，采用逻辑回归分析来分析手术时间（OT）、住院时间（HS）、估计失血量、淋巴结收获量和并发症的独立变量。独立预测因素包括病例数、临床分期、化疗后状态、术前腹膜后肿瘤肿块和体重指数。此外，将患者分为三组：A组（病例1 - 10）、B组（病例11 - 20）和C组（病例21 - 30）。进行Kruskal-Wallis检验以评估各组在OT、HS和淋巴结收获量方面的差异。随着病例数增加，OT显著降低（<0.001），HS受总体并发症的显著影响（=0.0006）。有2例主要围手术期并发症（6.6%）。没有因素能预测总体并发症或Clavien-Dindo I-II级或III-V级。Kruskal-Wallis检验显示C组在OT和HS方面有显著差异（<0.05）。对于生殖细胞肿瘤（GCTs）的R-RPLND显示出明显的学习曲线，随着外科医生经验的增加，OT、HS和并发症发生率有显著改善。总体而言，R-RPLND的低并发症发生率并未表明围手术期或术后并发症的预测因素。RPLND作为一种安全有效的GCTs治疗方法具有广阔前景，尤其是由专业中心经验丰富的外科医生进行时。
