Safety and Early Oncologic Effectiveness of Primary Robotic Retroperitoneal Lymph Node Dissection for Nonseminomatous Germ Cell Testicular Cancer

Shane M. Pearce, Shay Golan, Michael A. Gorin, Amy N. Luckenbaugh, Stephen Williams, John F. Ward, Jeffrey S. Montgomery, Khaled S. Hafez, Alon Z. Weizer, Phillip M. Pierorazio, Mohamad E. Allaf, Scott E. Eggener

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background: Primary robot-assisted retroperitoneal lymph node dissection (R-RPLND) has been studied as an alternative to open RPLND in single-institution series for patients with low-stage nonseminomatous germ cell tumors (NSGCT). Objective: To evaluate a multicenter series of primary R-RPLND for low-stage NSGCT. Design, setting, and participants: Between 2011 and 2015, 47 patients underwent primary R-RPLND at four centers for Clinical Stage (CS) I-IIA NSGCT. Surgical procedure: R-RPLND was performed using the da Vinci surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA). Outcome measurements and statistical analysis: Data were collected regarding patient demographics, primary tumor characteristics, pathologic findings, and clinical outcomes. Results and limitations: Forty-two patients (89%) were CS I and five (11%) were CS IIA. The median operative time was 235. min (interquartile range [IQR]: 214-258. min), estimated blood loss was 50. ml (IQR: 50-100. ml), node count was 26 (IQR: 18-32), and length of stay was 1 d. There were two intraoperative complications (4%), four early postoperative complications (9%), no late complications, and the rate of antegrade ejaculation was 100%. Of the eight patients (17%) with positive nodes (seven pN1and one pN2), five (62%) received adjuvant chemotherapy. The one recurrence was out of template in the pelvis after adjuvant chemotherapy (resected teratoma). The median follow-up was 16 mo and the 2-yr recurrence-free survival rate was 97% (95% confidence interval: 82-100%). Limitations include retrospective design and limited follow-up. Conclusions: Our multicenter experience supports R-RPLND as a potential option at experienced centers in select patients with low-stage NSGCT. Informal comparison to open and laparoscopic series suggests R-RPLND has an acceptably low morbidity profile, but oncologic efficacy evaluation requires further evaluation. Patient summary: We examined outcomes after robot-assisted retroperitoneal lymph node dissection for patients with low-stage nonseminomatous testicular cancer with our data suggesting the robotic approach has acceptable morbidity and early oncologic outcomes. The first multicenter experience with robot-assisted retroperitoneal lymph node dissection supports the technique as a potential management option at experienced centers in select patients with low-stage nonseminomatous germ cell tumors. Robot-assisted retroperitoneal lymph node dissection has an acceptably low morbidity profile, but oncologic efficacy evaluation requires longer follow-up.

Original languageEnglish (US)
JournalEuropean Urology
DOIs
StateAccepted/In press - 2016
Externally publishedYes

Fingerprint

Germ Cell and Embryonal Neoplasms
Testicular Neoplasms
Robotics
Lymph Node Excision
Safety
Adjuvant Chemotherapy
Morbidity
Recurrence
Statistical Data Interpretation
Ejaculation
Teratoma
Intraoperative Complications
Operative Time
Pelvis
Length of Stay
Survival Rate
Demography
Nonseminomatous germ cell tumor
Confidence Intervals

Keywords

  • Complications
  • Lymph node excision
  • Nonseminomatous germ cell tumor
  • Testicular neoplasms
  • Treatment outcome

ASJC Scopus subject areas

  • Urology

Cite this

Safety and Early Oncologic Effectiveness of Primary Robotic Retroperitoneal Lymph Node Dissection for Nonseminomatous Germ Cell Testicular Cancer. / Pearce, Shane M.; Golan, Shay; Gorin, Michael A.; Luckenbaugh, Amy N.; Williams, Stephen; Ward, John F.; Montgomery, Jeffrey S.; Hafez, Khaled S.; Weizer, Alon Z.; Pierorazio, Phillip M.; Allaf, Mohamad E.; Eggener, Scott E.

In: European Urology, 2016.

Research output: Contribution to journalArticle

Pearce, SM, Golan, S, Gorin, MA, Luckenbaugh, AN, Williams, S, Ward, JF, Montgomery, JS, Hafez, KS, Weizer, AZ, Pierorazio, PM, Allaf, ME & Eggener, SE 2016, 'Safety and Early Oncologic Effectiveness of Primary Robotic Retroperitoneal Lymph Node Dissection for Nonseminomatous Germ Cell Testicular Cancer', European Urology. https://doi.org/10.1016/j.eururo.2016.05.017
Pearce, Shane M. ; Golan, Shay ; Gorin, Michael A. ; Luckenbaugh, Amy N. ; Williams, Stephen ; Ward, John F. ; Montgomery, Jeffrey S. ; Hafez, Khaled S. ; Weizer, Alon Z. ; Pierorazio, Phillip M. ; Allaf, Mohamad E. ; Eggener, Scott E. / Safety and Early Oncologic Effectiveness of Primary Robotic Retroperitoneal Lymph Node Dissection for Nonseminomatous Germ Cell Testicular Cancer. In: European Urology. 2016.
@article{1b1d7bf7f0164dfd9f69b595894859e0,
title = "Safety and Early Oncologic Effectiveness of Primary Robotic Retroperitoneal Lymph Node Dissection for Nonseminomatous Germ Cell Testicular Cancer",
abstract = "Background: Primary robot-assisted retroperitoneal lymph node dissection (R-RPLND) has been studied as an alternative to open RPLND in single-institution series for patients with low-stage nonseminomatous germ cell tumors (NSGCT). Objective: To evaluate a multicenter series of primary R-RPLND for low-stage NSGCT. Design, setting, and participants: Between 2011 and 2015, 47 patients underwent primary R-RPLND at four centers for Clinical Stage (CS) I-IIA NSGCT. Surgical procedure: R-RPLND was performed using the da Vinci surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA). Outcome measurements and statistical analysis: Data were collected regarding patient demographics, primary tumor characteristics, pathologic findings, and clinical outcomes. Results and limitations: Forty-two patients (89{\%}) were CS I and five (11{\%}) were CS IIA. The median operative time was 235. min (interquartile range [IQR]: 214-258. min), estimated blood loss was 50. ml (IQR: 50-100. ml), node count was 26 (IQR: 18-32), and length of stay was 1 d. There were two intraoperative complications (4{\%}), four early postoperative complications (9{\%}), no late complications, and the rate of antegrade ejaculation was 100{\%}. Of the eight patients (17{\%}) with positive nodes (seven pN1and one pN2), five (62{\%}) received adjuvant chemotherapy. The one recurrence was out of template in the pelvis after adjuvant chemotherapy (resected teratoma). The median follow-up was 16 mo and the 2-yr recurrence-free survival rate was 97{\%} (95{\%} confidence interval: 82-100{\%}). Limitations include retrospective design and limited follow-up. Conclusions: Our multicenter experience supports R-RPLND as a potential option at experienced centers in select patients with low-stage NSGCT. Informal comparison to open and laparoscopic series suggests R-RPLND has an acceptably low morbidity profile, but oncologic efficacy evaluation requires further evaluation. Patient summary: We examined outcomes after robot-assisted retroperitoneal lymph node dissection for patients with low-stage nonseminomatous testicular cancer with our data suggesting the robotic approach has acceptable morbidity and early oncologic outcomes. The first multicenter experience with robot-assisted retroperitoneal lymph node dissection supports the technique as a potential management option at experienced centers in select patients with low-stage nonseminomatous germ cell tumors. Robot-assisted retroperitoneal lymph node dissection has an acceptably low morbidity profile, but oncologic efficacy evaluation requires longer follow-up.",
keywords = "Complications, Lymph node excision, Nonseminomatous germ cell tumor, Testicular neoplasms, Treatment outcome",
author = "Pearce, {Shane M.} and Shay Golan and Gorin, {Michael A.} and Luckenbaugh, {Amy N.} and Stephen Williams and Ward, {John F.} and Montgomery, {Jeffrey S.} and Hafez, {Khaled S.} and Weizer, {Alon Z.} and Pierorazio, {Phillip M.} and Allaf, {Mohamad E.} and Eggener, {Scott E.}",
year = "2016",
doi = "10.1016/j.eururo.2016.05.017",
language = "English (US)",
journal = "European Urology",
issn = "0302-2838",
publisher = "Elsevier",

}

TY - JOUR

T1 - Safety and Early Oncologic Effectiveness of Primary Robotic Retroperitoneal Lymph Node Dissection for Nonseminomatous Germ Cell Testicular Cancer

AU - Pearce, Shane M.

AU - Golan, Shay

AU - Gorin, Michael A.

AU - Luckenbaugh, Amy N.

AU - Williams, Stephen

AU - Ward, John F.

AU - Montgomery, Jeffrey S.

AU - Hafez, Khaled S.

AU - Weizer, Alon Z.

AU - Pierorazio, Phillip M.

AU - Allaf, Mohamad E.

AU - Eggener, Scott E.

PY - 2016

Y1 - 2016

N2 - Background: Primary robot-assisted retroperitoneal lymph node dissection (R-RPLND) has been studied as an alternative to open RPLND in single-institution series for patients with low-stage nonseminomatous germ cell tumors (NSGCT). Objective: To evaluate a multicenter series of primary R-RPLND for low-stage NSGCT. Design, setting, and participants: Between 2011 and 2015, 47 patients underwent primary R-RPLND at four centers for Clinical Stage (CS) I-IIA NSGCT. Surgical procedure: R-RPLND was performed using the da Vinci surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA). Outcome measurements and statistical analysis: Data were collected regarding patient demographics, primary tumor characteristics, pathologic findings, and clinical outcomes. Results and limitations: Forty-two patients (89%) were CS I and five (11%) were CS IIA. The median operative time was 235. min (interquartile range [IQR]: 214-258. min), estimated blood loss was 50. ml (IQR: 50-100. ml), node count was 26 (IQR: 18-32), and length of stay was 1 d. There were two intraoperative complications (4%), four early postoperative complications (9%), no late complications, and the rate of antegrade ejaculation was 100%. Of the eight patients (17%) with positive nodes (seven pN1and one pN2), five (62%) received adjuvant chemotherapy. The one recurrence was out of template in the pelvis after adjuvant chemotherapy (resected teratoma). The median follow-up was 16 mo and the 2-yr recurrence-free survival rate was 97% (95% confidence interval: 82-100%). Limitations include retrospective design and limited follow-up. Conclusions: Our multicenter experience supports R-RPLND as a potential option at experienced centers in select patients with low-stage NSGCT. Informal comparison to open and laparoscopic series suggests R-RPLND has an acceptably low morbidity profile, but oncologic efficacy evaluation requires further evaluation. Patient summary: We examined outcomes after robot-assisted retroperitoneal lymph node dissection for patients with low-stage nonseminomatous testicular cancer with our data suggesting the robotic approach has acceptable morbidity and early oncologic outcomes. The first multicenter experience with robot-assisted retroperitoneal lymph node dissection supports the technique as a potential management option at experienced centers in select patients with low-stage nonseminomatous germ cell tumors. Robot-assisted retroperitoneal lymph node dissection has an acceptably low morbidity profile, but oncologic efficacy evaluation requires longer follow-up.

AB - Background: Primary robot-assisted retroperitoneal lymph node dissection (R-RPLND) has been studied as an alternative to open RPLND in single-institution series for patients with low-stage nonseminomatous germ cell tumors (NSGCT). Objective: To evaluate a multicenter series of primary R-RPLND for low-stage NSGCT. Design, setting, and participants: Between 2011 and 2015, 47 patients underwent primary R-RPLND at four centers for Clinical Stage (CS) I-IIA NSGCT. Surgical procedure: R-RPLND was performed using the da Vinci surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA). Outcome measurements and statistical analysis: Data were collected regarding patient demographics, primary tumor characteristics, pathologic findings, and clinical outcomes. Results and limitations: Forty-two patients (89%) were CS I and five (11%) were CS IIA. The median operative time was 235. min (interquartile range [IQR]: 214-258. min), estimated blood loss was 50. ml (IQR: 50-100. ml), node count was 26 (IQR: 18-32), and length of stay was 1 d. There were two intraoperative complications (4%), four early postoperative complications (9%), no late complications, and the rate of antegrade ejaculation was 100%. Of the eight patients (17%) with positive nodes (seven pN1and one pN2), five (62%) received adjuvant chemotherapy. The one recurrence was out of template in the pelvis after adjuvant chemotherapy (resected teratoma). The median follow-up was 16 mo and the 2-yr recurrence-free survival rate was 97% (95% confidence interval: 82-100%). Limitations include retrospective design and limited follow-up. Conclusions: Our multicenter experience supports R-RPLND as a potential option at experienced centers in select patients with low-stage NSGCT. Informal comparison to open and laparoscopic series suggests R-RPLND has an acceptably low morbidity profile, but oncologic efficacy evaluation requires further evaluation. Patient summary: We examined outcomes after robot-assisted retroperitoneal lymph node dissection for patients with low-stage nonseminomatous testicular cancer with our data suggesting the robotic approach has acceptable morbidity and early oncologic outcomes. The first multicenter experience with robot-assisted retroperitoneal lymph node dissection supports the technique as a potential management option at experienced centers in select patients with low-stage nonseminomatous germ cell tumors. Robot-assisted retroperitoneal lymph node dissection has an acceptably low morbidity profile, but oncologic efficacy evaluation requires longer follow-up.

KW - Complications

KW - Lymph node excision

KW - Nonseminomatous germ cell tumor

KW - Testicular neoplasms

KW - Treatment outcome

UR - http://www.scopus.com/inward/record.url?scp=84971673850&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84971673850&partnerID=8YFLogxK

U2 - 10.1016/j.eururo.2016.05.017

DO - 10.1016/j.eururo.2016.05.017

M3 - Article

JO - European Urology

JF - European Urology

SN - 0302-2838

ER -