Perioperative safety and short-term oncological outcomes of minimally invasive retroperitoneal lymph node dissection
Fankhauser, C D Afferi, L. Stroup, S. P. Rocco, N. R. Olson, K. Bagrodia, A. Cazzaniga, W. Mayer, E. Nicol, D. Islamoglu, E.
Fankhauser, C D
Afferi, L.
Stroup, S. P.
Rocco, N. R.
Olson, K.
Bagrodia, A.
Cazzaniga, W.
Mayer, E.
Nicol, D.
Islamoglu, E.
Citations
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Abstract
Introduction & Objectives: Open Retroperitoneal Lymph Node Dissection (RPLND) is a treatment option in men with stage 1/2 testis cancer and
the standard of care in men with post-chemotherapy retroperitoneal residuals. Minimally invasive RPLND (miRPLND) has been introduced but only
limited data regarding safety and oncological outcomes are available.
Materials & Methods: International, multicentre, retrospective cohort study describing patient characteristics, perioperative safety and oncological
outcomes of men scheduled for miRPLND.
Results: 406 men (14 sites, 8 countries) were studied. Laparoscopic RPLND was performed in 57 and robotic RPLND in 349 men. Indications
included pre-chemotherapy RPLND in 261 including 8 with recurrence after one cycle of adjuvant chemotherapy for stage 1 disease and post-chemotherapy RPLND in 145. The median retroperitoneal mass size was 15mm (IQR 10-19, range 0-31) in pre-chemotherapy RPLND and 20 mm
(IQR 15-30, range 0-104) in post-chemotherapy RPLND. Median operative time was 265 minutes (IQR 201-334). Median intraoperative blood loss
was 75mL (IQR 50-200) with RBC transfusions in 11 men. Conversion to open surgery was performed in 13 (3%; access problems (6), bleeding
complications (4) with blood loss of 1000-6000mL and extent of disease (3)). Intraoperative complications occurred in 15 (4%) men (bleeding (9),
ureteric injury (4), bowel injury (1) and thoracic duct injury (1). Postoperative complications in 28 (7%) men included ascites and/or pleural effusion
(11), deep vein thrombosis (6), wound infection (3), rhabdomyolysis (2), incisional hernia (2), post-operative bleeding requiring transfusion (1),
clostridia difficile infection (1), limb compartment syndrome (1) and pneumonia (1). Median length of stay overall was 3 days (IQR 2-4) and in men
with complications 4 days (IQR 2-6). Within the first 30 days after operation 20 men (5%) were readmitted. During a median follow-up of 13 months (IQR 4-28), relapse was observed in 25 men (6%). Unusual sites of recurrence included the peritoneum around the sigmoid and port site in 1 patient
each. At the latest follow-up 401 (98%) men were disease free, 3 alive under treatment and 2 had died from progression.
Conclusions: In an international cohort, low blood loss and short hospital stay was reported for selected men with small volume retroperitoneal
disease undergoing pre- and post-chemotherapy miRPLND. Although complications were rare, miRPLND should only be performed in experienced
high-volume centres and surgical teams should be prepared for emergency conversion to open surgery because massive bleeding can occur.
Based on encouraging intraoperative safety data together with no concerning signal of peritoneal seeding during the short follow-up period,
prospective studies of miRPLND in high volume centres are justified to further evaluate miRPLND technique, complications, functional and
oncological outcomes.
Authors
Fankhauser, C D
Afferi, L.
Stroup, S. P.
Rocco, N. R.
Olson, K.
Bagrodia, A.
Cazzaniga, W.
Mayer, E.
Nicol, D.
Islamoglu, E.
De Vergie, S.
Ragheed, S.
Eggener, S. E.
Nazzani, S.
Nicolai, N.
Hugar, L.
Sexton, W. J.
Matei, D. V.
Hermanns, T.
Hamilton, R. J.
Hiester, A.
Albers, P.
Clarke, Noel W
Mattei, A.
Afferi, L.
Stroup, S. P.
Rocco, N. R.
Olson, K.
Bagrodia, A.
Cazzaniga, W.
Mayer, E.
Nicol, D.
Islamoglu, E.
De Vergie, S.
Ragheed, S.
Eggener, S. E.
Nazzani, S.
Nicolai, N.
Hugar, L.
Sexton, W. J.
Matei, D. V.
Hermanns, T.
Hamilton, R. J.
Hiester, A.
Albers, P.
Clarke, Noel W
Mattei, A.
Description
Date
2021
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Fankhauser CD, Afferi L, Stroup SP, Rocco NR, Olson K, Bagrodia A, et al. Perioperative safety and short-term oncological outcomes of minimally invasive retroperitoneal lymph node dissection. European Urology. 2021;79:S911-S2.