Open Versus Robotic RPLND for Patients With Testicular Cancer

While open retroperitoneal lymph node dissection (RPLND) is the primary method for the dissection of retroperitoneal lymph nodes, robotic RPLND has demonstrated lower blood loss, shorter length of stay (LOS), faster recovery, and superior cosmetic results.

Julian Chavarriaga, MD, and colleagues conducted a retrospective review of patients with testicular cancer who underwent primary open (O-RPLND) or robotic (R-RPLND) RPLND to evaluate oncological risks and benefits.

The study was presented at the 2024 American Urological Association Annual Meeting.

Researchers used a 2:1 propensity score matching (PSM) analysis to calibrate for the inherent differences between those undergoing O-RPLND and R-RPLND. The primary end point was establishing the risk of relapse connected with both surgical approaches. The secondary end point was evaluating perioperative outcomes, including operative time, LOS, estimated blood loss (EBL), need for transfusion, and surgical complications.

Of the 178 participants, 137 received O-RPLND and 41 received R-RPLND. Twenty-six patients matched into the R-RPLND cohort, while 38 matched into the O-RPLND cohort following PSM. Researchers noted no major differences between the cohorts following matching.

After a median follow-up of 23.6 months, 1 patient relapsed in the R-RPLND group compared with 3 in the O-RPLND group. Those who underwent R-RPLND experienced a lower median LOS (1 vs 5 days; P<.0001) and a lower median EBL (200 vs 300 ml; P=.032). Researchers found no major difference in the complication rate between the 2 cohorts.

“To the best of our knowledge, this is the first study to compare O-RPLND and R-RPLND using a PSM system, making these results the closest to what a prospective randomized data set may show,” the researchers wrote. “We encourage the inclusion of primary R-RPLND into care algorithms for patients with de novo [clinical stage (CS) II] and CS I with retroperitoneal relapse provided the surgery is done at centers of excellence with high-volume experience in RPLND.”