Matched-pair analysis of peri-operative and oncological outcomes of robot-assisted vs open retroperitoneal lymph node dissection.

Abstract

To analyse a comparatively large cohort of patients who underwent robot-assisted retroperitoneal lymph node dissection (R-RPLND) in a single centre, assessing the peri-operative and oncological safety of this procedure compared to that in a matched-pair cohort of patients who underwent open retroperitoneal lymph node dissection (O-RPLND). We retrospectively identified 100 patients who underwent R-RPLND between October 2010 and January 2024. A matched-pair analysis of R-RPLNDs and O-RPLNDs was conducted based on the following criteria: surgical indication, histology, clinical stage (CS), and tumour size. The primary endpoint of this analysis was progression-free survival (PFS). Secondary endpoints were peri-operative parameters. Based on surgical indication, the R-RPLND cohort was divided into four groups: CS II seminoma (Group 1, 42 patients); marker-negative CS II non-seminoma (Group 2, 15 patients); CS I non-seminoma with high-risk factors (Group 3, seven patients), and post-chemotherapy patients (Group 4, 34 patients). Two patients were excluded due to uncommon testicular histology. With a mean follow-up of 32, 31, 32 and 28 months in the four groups, respectively, relapses occurred in 10/42 of Group 1, 3/15 of Group 2, and 1/7 of Group 3, while all patients remained relapse-free in Group 4. The matched-pair analysis revealed that histological retroperitoneal lymph node dissection specimens, relapse rates, and PFS were similar in the R-RPLND and O-RPLND groups. R-RPLND had advantages in terms of a shorter hospital stay as a surrogate for less morbidity. In selected patients and selected surgical indications, R-RPLND represents a minimally invasive alternative to O-RPLND in the management of patients with testicular germ cell tumours.