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A comparative study of peri-operative outcomes for 100 consecutive post-chemotherapy and primary robot-assisted and open retroperitoneal lymph node dissections

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A Letter to the Editor to this article was published on 22 January 2022

Abstract

Purpose

To describe and compare differences in peri-operative outcomes of robot-assisted (RA-RPLND) and open (O-RPLND) retroperitoneal lymph node dissection performed by a single surgeon where chemotherapy is the standard initial treatment for Stage 2 or greater non-seminomatous germ cell tumour.

Methods

Review of a prospective database of all RA-RPLNDs (28 patients) and O-RPLNDs (72 patients) performed by a single surgeon from 2014 to 2020. Peri-operative outcomes were compared for patients having RA-RPLND to all O-RPLNDs and a matched cohort of patients having O-RPLND (20 patients). Further comparison was performed between all patients in the RA-RPLND group (21 patients) and matched O-RPLND group (18 patients) who had previous chemotherapy. RA-RPLND was performed for patients suitable for a unilateral template dissection. O-RPLND was performed prior to the introduction of RA-RPLND and for patients not suitable for RA-RPLND after its introduction.

Results

RA-RPLND showed improved peri-operative outcomes compared to the matched cohort of O-RPLND—median blood loss (50 versus 400 ml, p < 0.00001), operative duration (150 versus 195 min, p = 0.023) length-of-stay (1 versus 5 days, p < 0.00001) and anejaculation (0 versus 4, p = 0.0249). There was no statistical difference in complication rates. RA-RPLND had lower median lymph node yields although not significant (9 versus 13, p = 0.070). These improved peri-operative outcomes were also seen in the post-chemotherapy RA-RPLND versus O-RPLND analysis. There were no tumour recurrences seen in either group with median follow-up of 36 months and 60 months, respectively.

Conclusions

Post-chemotherapy RA-RPLND may have decreased blood loss, operative duration, hospital length-of-stay and anejaculation rates in selected cases and should, therefore, be considered in selected patients. Differences in oncological outcomes require longer term follow-up.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

No funds, grants, or other support were received.

Author information

Author notes

  1. Paul Lloyd and Anne Hong equally contributed to this work.

Authors and Affiliations

  1. Department of Urology, Addenbrooke’s Hospital, Cambridge University Hospitals, Cambridge, UK

    Paul Lloyd, Elaine W. Y. Lee, Harveer S. Dev, Maurice H. Coret, Richard Knight, David E. Neal & Benjamin C. Thomas

  2. Department of Urology, Royal Melbourne Hospital, Melbourne, Australia

    Anne Hong, Marc A. Furrer, Nathan Lawrentschuk & Benjamin C. Thomas

  3. Department of Urology, Lister Hospital, Stevenage, UK

    James M. Adshead

  4. Department of Gynae-Oncology, Addenbrooke’s Hospital, Cambridge, UK

    Peter Baldwin

  5. Department of Oncology, St Bartholomew’s Hospital, London, UK

    Jonathan Shamash

  6. Department of Oncology, University College London Hospital, London, UK

    Constantine Alifrangis & Sara Stoneham

  7. Department of Oncology, Addenbrooke’s Hospital, Cambridge University Hospitals, Cambridge, UK

    Danish Mazhar & Han Wong

  8. Department of Pathology, Addenbrooke’s Hospital, Cambridge University Hospitals, Cambridge, UK

    Anne Warren

  9. Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia

    Ben Tran

  10. Department of Urology, University Hospital of Bern, Bern, Switzerland

    Marc A. Furrer

  11. The Australian Medical Robotics Academy, Melbourne, Australia

    Marc A. Furrer & Benjamin C. Thomas

  12. Department of Oncology, University of Melbourne, Melbourne, Australia

    Ben Tran

  13. Department of Surgery, University of Melbourne, Melbourne, Australia

    Nathan Lawrentschuk & Benjamin C. Thomas

Authors
  1. Paul Lloyd
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  2. Anne Hong
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  3. Marc A. Furrer
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Contributions

PL and BT participated in conception and design, statistical analysis, analysis and interpretation of data, and manuscript drafting. AH, EL, HD, JS, CA, SS, DM, HW, NL and AW collected the clinical data and analysis and interpretation of data. MF contributed to analysis and interpretation of data, and manuscript drafting. DN participated in project supervision. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Benjamin C. Thomas.

Ethics declarations

Conflict of interest

Paul Lloyd, Anne Hong, Marc A. Furrer, Elaine WY Lee, Harveer S Dev, Maurice H Coret, James M Adshead, Peter Baldwin, Richard Knight, Jonathan Shamash, Constantine Alifrangis, Sara Stoneham, Danish Mazhar, Han Wong, Anne Warren, Ben Tran, Nathan Lawrentschuk, David E Neal and Benjamin C Thomas have nothing to disclose.

Ethical approval

Approval was obtained from the local ethics committee. Informed consent was waived by the institutional review board in view of the retrospective nature of the study. All the procedures being performed were part of the routine care.

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Lloyd, P., Hong, A., Furrer, M.A. et al. A comparative study of peri-operative outcomes for 100 consecutive post-chemotherapy and primary robot-assisted and open retroperitoneal lymph node dissections. World J Urol 40, 119–126 (2022). https://doi.org/10.1007/s00345-021-03832-0

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  • DOI: https://doi.org/10.1007/s00345-021-03832-0

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