Open Versus Robotic RPLND in Clinical Stage II Testicular Cancer

Robotic primary retroperitoneal lymph node dissection (R-RPLND) may offer lower morbidity and improved perioperative outcomes than open RPLND (O-RPLND) for patients with clinical stage II (CS II) testicular cancer, according to new research presented at the 24th Annual Meeting of the Society of Urologic Oncology.

O-RPLND is considered by many to be the gold standard for primary dissection of the retroperitoneal lymph nodes, though an increased utilization of R-RPLND has been observed in recent years because of its potential for lower blood loss, shorter hospital length of stay (LOS), faster recovery, and superior cosmetic results. A comparison of oncological and perioperative outcomes between these surgical approaches is needed, along with data pertaining to the oncological risks and benefits from retrospective studies.

Julian Chavarriaga, MD, and colleagues conducted a retrospective review of 178 patients (O-RPLND, n=137; R-RPLND, n=41) with CS II testicular cancer between 1990 and 2022. A 2:1 propensity score matching analysis adjusted for the effects of inherent differences between patients undergoing O-RPLND and R-RPLND. The primary end point was risk of relapse associated with both surgical approaches. The secondary end point was to evaluate perioperative outcomes, including operative time, hospital LOS, estimated blood loss (EBL), need for transfusion, and surgical complications.

Additionally, researchers utilized the Kaplan-Meier product-limit method to calculate relapse-free survival, and a log-rank test was used to assess the impact of both surgical approaches.

After propensity score matching, 26 patients were matched in the R-RPLND group and 38 patients were matched in the O-RPLND group. The distribution showed no significant differences between the 2 groups after matching.

With a median follow-up of 23.6 months, 1 patient (3.85%) relapsed in the R-RPLND group versus 3 (7.89%) in the O-RPLND group, though this difference was not statistically significant (P=.7074).

Researchers found that R-RPLND was associated with a lower median LOS (1 vs 5 days; P<.0001) and lower median EBL (200 vs 300 ml; P=.032) than O-RPLND. No significant difference was noted in the complication rate (23.08% vs 25.00%, respectively), but the median operating room time was significantly increased with robotic surgery (8.8 vs 4.3 hours, respectively; P<.0001).

“Primary R-RPLND offers low morbidity and improved perioperative outcomes, while maintaining the excellent oncologic efficacy of the open approach,” Dr. Chavarriaga and colleagues concluded. “We encourage the inclusion of primary R-RPLND into care algorithms for patients with de novo CS II and [clinical stage I disease] with retroperitoneal relapse, provided the surgery is done at centers of excellence with high-volume experience in RPLND.”