Primary robotic RLPND for nonseminomatous germ cell testicular cancer: a two-center analysis of intermediate oncologic and safety outcomes

Nicholas R. Rocco, Sean P. Stroup, Haidar M. Abdul-Muhsin, Michael T. Marshall, Michael G. Santomauro, Matthew S. Christman, James O. L’Esperance, Erik P. Castle

Research output: Contribution to journalArticle

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Abstract

Objective: To evaluate the intermediate-term oncologic outcomes and safety profile of the largest case series of primary robotic retroperitoneal lymphadenectomy for low-clinical-stage non-seminomatous germ cell testicular cancer. Methods: This was a two-center retrospective analysis of robotic RPLND cases for low-clinical-stage (stage I–IIB) non-seminomatous germ cell testicular cancer in the primary setting. Demographic, perioperative, operative and oncologic variables were collected between March 2008 and May 2019. Descriptive analyses were performed and presented as medians with interquartile ranges for continuous variables and frequency and proportions for categorical variables. A survival analysis of time to recurrence was performed using Cox proportional hazards model. Using logistic regression, risk factors for complications were analyzed. Both univariate and multivariate analyses were performed. Results: A total of 58 patients (CS 1 = 56, CS IIA = 2, CS IIB = 0) were identified. The median follow-up was 47 months and the 2-year recurrence-free survival rate was 91%. The five recurrences were all out of the performed dissection template (pelvis = 1 and lung = 4). Only five patients (29%) with occult metastasis underwent adjuvant chemotherapy. The median operative time was 319 min [interquartile range (IQR) 276–355 min], estimated blood loss was 100 ml (IQR 75–200 ml), node count was 26 (IQR 20–31), and length of stay 2 d (IQR 1–3 days). There were 2 (3.3%) intraoperative complications, 19 (32.7%) 30-day postoperative complications to include 14 (24.1%) Clavien grade I, 4 (6.9%) Clavien grade II, 1 (1.7%) Clavien grade III and 0 Clavien grade IV complications. No statistical significance was found on multivariate or univariate analysis for survival analysis of time to recurrence and risk factors for complications. Conclusions: This study represents the largest case series of primary R-RPLND for the treatment of low-stage non-seminomatous germ cell tumors (NSGCT). With 47 months of follow-up and a low rate of adjuvant chemotherapy, intermediate oncologic efficacy appears to be comparable to the gold standard open approach.

Original languageEnglish (US)
JournalWorld Journal of Urology
DOIs
StateAccepted/In press - Jan 1 2019

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Germ Cell and Embryonal Neoplasms
Testicular Neoplasms
Robotics
Safety
Recurrence
Adjuvant Chemotherapy
Survival Analysis
Intraoperative Complications
Operative Time
Lymph Node Excision
Pelvis
Proportional Hazards Models
Dissection
Length of Stay
Multivariate Analysis
Survival Rate
Logistic Models
Demography
Neoplasm Metastasis
Lung

Keywords

  • NSGCT
  • Retroperitoneal lymph node dissection
  • Robotic surgery
  • RPLND
  • Testicular cancer

ASJC Scopus subject areas

  • Urology

Cite this

Primary robotic RLPND for nonseminomatous germ cell testicular cancer : a two-center analysis of intermediate oncologic and safety outcomes. / Rocco, Nicholas R.; Stroup, Sean P.; Abdul-Muhsin, Haidar M.; Marshall, Michael T.; Santomauro, Michael G.; Christman, Matthew S.; L’Esperance, James O.; Castle, Erik P.

In: World Journal of Urology, 01.01.2019.

Research output: Contribution to journalArticle

Rocco, Nicholas R. ; Stroup, Sean P. ; Abdul-Muhsin, Haidar M. ; Marshall, Michael T. ; Santomauro, Michael G. ; Christman, Matthew S. ; L’Esperance, James O. ; Castle, Erik P. / Primary robotic RLPND for nonseminomatous germ cell testicular cancer : a two-center analysis of intermediate oncologic and safety outcomes. In: World Journal of Urology. 2019.
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abstract = "Objective: To evaluate the intermediate-term oncologic outcomes and safety profile of the largest case series of primary robotic retroperitoneal lymphadenectomy for low-clinical-stage non-seminomatous germ cell testicular cancer. Methods: This was a two-center retrospective analysis of robotic RPLND cases for low-clinical-stage (stage I–IIB) non-seminomatous germ cell testicular cancer in the primary setting. Demographic, perioperative, operative and oncologic variables were collected between March 2008 and May 2019. Descriptive analyses were performed and presented as medians with interquartile ranges for continuous variables and frequency and proportions for categorical variables. A survival analysis of time to recurrence was performed using Cox proportional hazards model. Using logistic regression, risk factors for complications were analyzed. Both univariate and multivariate analyses were performed. Results: A total of 58 patients (CS 1 = 56, CS IIA = 2, CS IIB = 0) were identified. The median follow-up was 47 months and the 2-year recurrence-free survival rate was 91{\%}. The five recurrences were all out of the performed dissection template (pelvis = 1 and lung = 4). Only five patients (29{\%}) with occult metastasis underwent adjuvant chemotherapy. The median operative time was 319 min [interquartile range (IQR) 276–355 min], estimated blood loss was 100 ml (IQR 75–200 ml), node count was 26 (IQR 20–31), and length of stay 2 d (IQR 1–3 days). There were 2 (3.3{\%}) intraoperative complications, 19 (32.7{\%}) 30-day postoperative complications to include 14 (24.1{\%}) Clavien grade I, 4 (6.9{\%}) Clavien grade II, 1 (1.7{\%}) Clavien grade III and 0 Clavien grade IV complications. No statistical significance was found on multivariate or univariate analysis for survival analysis of time to recurrence and risk factors for complications. Conclusions: This study represents the largest case series of primary R-RPLND for the treatment of low-stage non-seminomatous germ cell tumors (NSGCT). With 47 months of follow-up and a low rate of adjuvant chemotherapy, intermediate oncologic efficacy appears to be comparable to the gold standard open approach.",
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T2 - a two-center analysis of intermediate oncologic and safety outcomes

AU - Rocco, Nicholas R.

AU - Stroup, Sean P.

AU - Abdul-Muhsin, Haidar M.

AU - Marshall, Michael T.

AU - Santomauro, Michael G.

AU - Christman, Matthew S.

AU - L’Esperance, James O.

AU - Castle, Erik P.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: To evaluate the intermediate-term oncologic outcomes and safety profile of the largest case series of primary robotic retroperitoneal lymphadenectomy for low-clinical-stage non-seminomatous germ cell testicular cancer. Methods: This was a two-center retrospective analysis of robotic RPLND cases for low-clinical-stage (stage I–IIB) non-seminomatous germ cell testicular cancer in the primary setting. Demographic, perioperative, operative and oncologic variables were collected between March 2008 and May 2019. Descriptive analyses were performed and presented as medians with interquartile ranges for continuous variables and frequency and proportions for categorical variables. A survival analysis of time to recurrence was performed using Cox proportional hazards model. Using logistic regression, risk factors for complications were analyzed. Both univariate and multivariate analyses were performed. Results: A total of 58 patients (CS 1 = 56, CS IIA = 2, CS IIB = 0) were identified. The median follow-up was 47 months and the 2-year recurrence-free survival rate was 91%. The five recurrences were all out of the performed dissection template (pelvis = 1 and lung = 4). Only five patients (29%) with occult metastasis underwent adjuvant chemotherapy. The median operative time was 319 min [interquartile range (IQR) 276–355 min], estimated blood loss was 100 ml (IQR 75–200 ml), node count was 26 (IQR 20–31), and length of stay 2 d (IQR 1–3 days). There were 2 (3.3%) intraoperative complications, 19 (32.7%) 30-day postoperative complications to include 14 (24.1%) Clavien grade I, 4 (6.9%) Clavien grade II, 1 (1.7%) Clavien grade III and 0 Clavien grade IV complications. No statistical significance was found on multivariate or univariate analysis for survival analysis of time to recurrence and risk factors for complications. Conclusions: This study represents the largest case series of primary R-RPLND for the treatment of low-stage non-seminomatous germ cell tumors (NSGCT). With 47 months of follow-up and a low rate of adjuvant chemotherapy, intermediate oncologic efficacy appears to be comparable to the gold standard open approach.

AB - Objective: To evaluate the intermediate-term oncologic outcomes and safety profile of the largest case series of primary robotic retroperitoneal lymphadenectomy for low-clinical-stage non-seminomatous germ cell testicular cancer. Methods: This was a two-center retrospective analysis of robotic RPLND cases for low-clinical-stage (stage I–IIB) non-seminomatous germ cell testicular cancer in the primary setting. Demographic, perioperative, operative and oncologic variables were collected between March 2008 and May 2019. Descriptive analyses were performed and presented as medians with interquartile ranges for continuous variables and frequency and proportions for categorical variables. A survival analysis of time to recurrence was performed using Cox proportional hazards model. Using logistic regression, risk factors for complications were analyzed. Both univariate and multivariate analyses were performed. Results: A total of 58 patients (CS 1 = 56, CS IIA = 2, CS IIB = 0) were identified. The median follow-up was 47 months and the 2-year recurrence-free survival rate was 91%. The five recurrences were all out of the performed dissection template (pelvis = 1 and lung = 4). Only five patients (29%) with occult metastasis underwent adjuvant chemotherapy. The median operative time was 319 min [interquartile range (IQR) 276–355 min], estimated blood loss was 100 ml (IQR 75–200 ml), node count was 26 (IQR 20–31), and length of stay 2 d (IQR 1–3 days). There were 2 (3.3%) intraoperative complications, 19 (32.7%) 30-day postoperative complications to include 14 (24.1%) Clavien grade I, 4 (6.9%) Clavien grade II, 1 (1.7%) Clavien grade III and 0 Clavien grade IV complications. No statistical significance was found on multivariate or univariate analysis for survival analysis of time to recurrence and risk factors for complications. Conclusions: This study represents the largest case series of primary R-RPLND for the treatment of low-stage non-seminomatous germ cell tumors (NSGCT). With 47 months of follow-up and a low rate of adjuvant chemotherapy, intermediate oncologic efficacy appears to be comparable to the gold standard open approach.

KW - NSGCT

KW - Retroperitoneal lymph node dissection

KW - Robotic surgery

KW - RPLND

KW - Testicular cancer

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