Primary robotic RLPND for nonseminomatous germ cell testicular cancer: a two-center analysis of intermediate oncologic and safety outcomes
Objective To evaluate the intermediate-term oncologic outcomes and safety profile of the largest case series of primary robotic retroperitoneal lymphadenectomy for low-clinical-stage non-seminomatous germ cell testicular cancer. Methods This was a two-center retrospective analysis of robotic RPLND c...
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| Veröffentlicht in: | World journal of urology 2020-04, Vol.38 (4), p.859-867 |
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| creator | Rocco, Nicholas R. Stroup, Sean P. Abdul-Muhsin, Haidar M. Marshall, Michael T. Santomauro, Michael G. Christman, Matthew S. L’Esperance, James O. Castle, Erik P. |
| description | Objective
To evaluate the intermediate-term oncologic outcomes and safety profile of the largest case series of primary robotic retroperitoneal lymphadenectomy for low-clinical-stage non-seminomatous germ cell testicular cancer.
Methods
This was a two-center retrospective analysis of robotic RPLND cases for low-clinical-stage (stage I–IIB) non-seminomatous germ cell testicular cancer in the primary setting. Demographic, perioperative, operative and oncologic variables were collected between March 2008 and May 2019. Descriptive analyses were performed and presented as medians with interquartile ranges for continuous variables and frequency and proportions for categorical variables. A survival analysis of time to recurrence was performed using Cox proportional hazards model. Using logistic regression, risk factors for complications were analyzed. Both univariate and multivariate analyses were performed.
Results
A total of 58 patients (CS 1 = 56, CS IIA = 2, CS IIB = 0) were identified. The median follow-up was 47 months and the 2-year recurrence-free survival rate was 91%. The five recurrences were all out of the performed dissection template (pelvis = 1 and lung = 4). Only five patients (29%) with occult metastasis underwent adjuvant chemotherapy. The median operative time was 319 min [interquartile range (IQR) 276–355 min], estimated blood loss was 100 ml (IQR 75–200 ml), node count was 26 (IQR 20–31), and length of stay 2 d (IQR 1–3 days). There were 2 (3.3%) intraoperative complications, 19 (32.7%) 30-day postoperative complications to include 14 (24.1%) Clavien grade I, 4 (6.9%) Clavien grade II, 1 (1.7%) Clavien grade III and 0 Clavien grade IV complications. No statistical significance was found on multivariate or univariate analysis for survival analysis of time to recurrence and risk factors for complications.
Conclusions
This study represents the largest case series of primary R-RPLND for the treatment of low-stage non-seminomatous germ cell tumors (NSGCT). With 47 months of follow-up and a low rate of adjuvant chemotherapy, intermediate oncologic efficacy appears to be comparable to the gold standard open approach. |
| doi_str_mv | 10.1007/s00345-019-02900-w |
| format | Article |
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To evaluate the intermediate-term oncologic outcomes and safety profile of the largest case series of primary robotic retroperitoneal lymphadenectomy for low-clinical-stage non-seminomatous germ cell testicular cancer.
Methods
This was a two-center retrospective analysis of robotic RPLND cases for low-clinical-stage (stage I–IIB) non-seminomatous germ cell testicular cancer in the primary setting. Demographic, perioperative, operative and oncologic variables were collected between March 2008 and May 2019. Descriptive analyses were performed and presented as medians with interquartile ranges for continuous variables and frequency and proportions for categorical variables. A survival analysis of time to recurrence was performed using Cox proportional hazards model. Using logistic regression, risk factors for complications were analyzed. Both univariate and multivariate analyses were performed.
Results
A total of 58 patients (CS 1 = 56, CS IIA = 2, CS IIB = 0) were identified. The median follow-up was 47 months and the 2-year recurrence-free survival rate was 91%. The five recurrences were all out of the performed dissection template (pelvis = 1 and lung = 4). Only five patients (29%) with occult metastasis underwent adjuvant chemotherapy. The median operative time was 319 min [interquartile range (IQR) 276–355 min], estimated blood loss was 100 ml (IQR 75–200 ml), node count was 26 (IQR 20–31), and length of stay 2 d (IQR 1–3 days). There were 2 (3.3%) intraoperative complications, 19 (32.7%) 30-day postoperative complications to include 14 (24.1%) Clavien grade I, 4 (6.9%) Clavien grade II, 1 (1.7%) Clavien grade III and 0 Clavien grade IV complications. No statistical significance was found on multivariate or univariate analysis for survival analysis of time to recurrence and risk factors for complications.
Conclusions
This study represents the largest case series of primary R-RPLND for the treatment of low-stage non-seminomatous germ cell tumors (NSGCT). With 47 months of follow-up and a low rate of adjuvant chemotherapy, intermediate oncologic efficacy appears to be comparable to the gold standard open approach.</description><identifier>ISSN: 0724-4983</identifier><identifier>EISSN: 1433-8726</identifier><identifier>DOI: 10.1007/s00345-019-02900-w</identifier><identifier>PMID: 31502033</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adult ; Cancer ; Chemotherapy ; Humans ; Lymph Node Excision - adverse effects ; Lymph Node Excision - methods ; Male ; Medicine ; Medicine & Public Health ; Metastases ; Neoplasms, Germ Cell and Embryonal - surgery ; Nephrology ; Oncology ; Patients ; Pelvis ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Retroperitoneal Space ; Retrospective Studies ; Risk Factors ; Robotic Surgical Procedures - adverse effects ; Robotics ; Survival analysis ; Testes ; Testicular cancer ; Testicular Neoplasms - surgery ; Time Factors ; Topic Paper ; Treatment Outcome ; Tumors ; Urology ; Young Adult</subject><ispartof>World journal of urology, 2020-04, Vol.38 (4), p.859-867</ispartof><rights>This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2019</rights><rights>This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2019.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-1bb505caf8d1dfffec34b86ab307a5f8df435ad545117ef0cd83abbd76bfcddc3</citedby><cites>FETCH-LOGICAL-c375t-1bb505caf8d1dfffec34b86ab307a5f8df435ad545117ef0cd83abbd76bfcddc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00345-019-02900-w$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00345-019-02900-w$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31502033$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rocco, Nicholas R.</creatorcontrib><creatorcontrib>Stroup, Sean P.</creatorcontrib><creatorcontrib>Abdul-Muhsin, Haidar M.</creatorcontrib><creatorcontrib>Marshall, Michael T.</creatorcontrib><creatorcontrib>Santomauro, Michael G.</creatorcontrib><creatorcontrib>Christman, Matthew S.</creatorcontrib><creatorcontrib>L’Esperance, James O.</creatorcontrib><creatorcontrib>Castle, Erik P.</creatorcontrib><title>Primary robotic RLPND for nonseminomatous germ cell testicular cancer: a two-center analysis of intermediate oncologic and safety outcomes</title><title>World journal of urology</title><addtitle>World J Urol</addtitle><addtitle>World J Urol</addtitle><description>Objective
To evaluate the intermediate-term oncologic outcomes and safety profile of the largest case series of primary robotic retroperitoneal lymphadenectomy for low-clinical-stage non-seminomatous germ cell testicular cancer.
Methods
This was a two-center retrospective analysis of robotic RPLND cases for low-clinical-stage (stage I–IIB) non-seminomatous germ cell testicular cancer in the primary setting. Demographic, perioperative, operative and oncologic variables were collected between March 2008 and May 2019. Descriptive analyses were performed and presented as medians with interquartile ranges for continuous variables and frequency and proportions for categorical variables. A survival analysis of time to recurrence was performed using Cox proportional hazards model. Using logistic regression, risk factors for complications were analyzed. Both univariate and multivariate analyses were performed.
Results
A total of 58 patients (CS 1 = 56, CS IIA = 2, CS IIB = 0) were identified. The median follow-up was 47 months and the 2-year recurrence-free survival rate was 91%. The five recurrences were all out of the performed dissection template (pelvis = 1 and lung = 4). Only five patients (29%) with occult metastasis underwent adjuvant chemotherapy. The median operative time was 319 min [interquartile range (IQR) 276–355 min], estimated blood loss was 100 ml (IQR 75–200 ml), node count was 26 (IQR 20–31), and length of stay 2 d (IQR 1–3 days). There were 2 (3.3%) intraoperative complications, 19 (32.7%) 30-day postoperative complications to include 14 (24.1%) Clavien grade I, 4 (6.9%) Clavien grade II, 1 (1.7%) Clavien grade III and 0 Clavien grade IV complications. No statistical significance was found on multivariate or univariate analysis for survival analysis of time to recurrence and risk factors for complications.
Conclusions
This study represents the largest case series of primary R-RPLND for the treatment of low-stage non-seminomatous germ cell tumors (NSGCT). With 47 months of follow-up and a low rate of adjuvant chemotherapy, intermediate oncologic efficacy appears to be comparable to the gold standard open approach.</description><subject>Adult</subject><subject>Cancer</subject><subject>Chemotherapy</subject><subject>Humans</subject><subject>Lymph Node Excision - adverse effects</subject><subject>Lymph Node Excision - methods</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastases</subject><subject>Neoplasms, Germ Cell and Embryonal - surgery</subject><subject>Nephrology</subject><subject>Oncology</subject><subject>Patients</subject><subject>Pelvis</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Retroperitoneal Space</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Robotic Surgical Procedures - adverse effects</subject><subject>Robotics</subject><subject>Survival analysis</subject><subject>Testes</subject><subject>Testicular cancer</subject><subject>Testicular Neoplasms - surgery</subject><subject>Time Factors</subject><subject>Topic Paper</subject><subject>Treatment Outcome</subject><subject>Tumors</subject><subject>Urology</subject><subject>Young Adult</subject><issn>0724-4983</issn><issn>1433-8726</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kU9rFTEUxYMo9ln9Ai4k4MZN7M1kMpnXXamtCg9biq5D_pYpM0mbZHi8r9BP3bxOteCiq8DN757LOQehjxS-UgBxlAFYywnQNYFmDUC2r9CKtoyRXjTda7QC0bSkXffsAL3L-QaAig74W3TAKIcGGFuh-8s0TCrtcIo6lsHgq83lr2_Yx4RDDNlNQ4iTKnHO-NqlCRs3jri4XNF5VAkbFYxLx1jhso3EuFBcwiqocZeHjKPHw34yOTuo4nAMJo7xup5RweKsvCs7HOdi4uTye_TGqzG7D0_vIfpzfvb79AfZXHz_eXqyIYYJXgjVmgM3yveWWu-9M6zVfac0A6F4nfqWcWV5yykVzoOxPVNaW9Fpb6w17BB9WXRvU7ybqxU5DXnvSwVXfcqm6XuAjq5pRT__h97EOVV3j5RoKHQdq1SzUCbFnJPz8nYJVVKQ-6bk0pSsTcnHpuS2Ln16kp51jeffyt9qKsAWINevUMN_vv2C7AMLO6Lg</recordid><startdate>20200401</startdate><enddate>20200401</enddate><creator>Rocco, Nicholas R.</creator><creator>Stroup, Sean P.</creator><creator>Abdul-Muhsin, Haidar M.</creator><creator>Marshall, Michael T.</creator><creator>Santomauro, Michael G.</creator><creator>Christman, Matthew S.</creator><creator>L’Esperance, James O.</creator><creator>Castle, Erik P.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20200401</creationdate><title>Primary robotic RLPND for nonseminomatous germ cell testicular cancer: a two-center analysis of intermediate oncologic and safety outcomes</title><author>Rocco, Nicholas R. ; Stroup, Sean P. ; Abdul-Muhsin, Haidar M. ; Marshall, Michael T. ; Santomauro, Michael G. ; Christman, Matthew S. ; L’Esperance, James O. ; Castle, Erik P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-1bb505caf8d1dfffec34b86ab307a5f8df435ad545117ef0cd83abbd76bfcddc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Cancer</topic><topic>Chemotherapy</topic><topic>Humans</topic><topic>Lymph Node Excision - adverse effects</topic><topic>Lymph Node Excision - methods</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metastases</topic><topic>Neoplasms, Germ Cell and Embryonal - surgery</topic><topic>Nephrology</topic><topic>Oncology</topic><topic>Patients</topic><topic>Pelvis</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Retroperitoneal Space</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Robotic Surgical Procedures - adverse effects</topic><topic>Robotics</topic><topic>Survival analysis</topic><topic>Testes</topic><topic>Testicular cancer</topic><topic>Testicular Neoplasms - surgery</topic><topic>Time Factors</topic><topic>Topic Paper</topic><topic>Treatment Outcome</topic><topic>Tumors</topic><topic>Urology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rocco, Nicholas R.</creatorcontrib><creatorcontrib>Stroup, Sean P.</creatorcontrib><creatorcontrib>Abdul-Muhsin, Haidar M.</creatorcontrib><creatorcontrib>Marshall, Michael T.</creatorcontrib><creatorcontrib>Santomauro, Michael G.</creatorcontrib><creatorcontrib>Christman, Matthew S.</creatorcontrib><creatorcontrib>L’Esperance, James O.</creatorcontrib><creatorcontrib>Castle, Erik P.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>World journal of urology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rocco, Nicholas R.</au><au>Stroup, Sean P.</au><au>Abdul-Muhsin, Haidar M.</au><au>Marshall, Michael T.</au><au>Santomauro, Michael G.</au><au>Christman, Matthew S.</au><au>L’Esperance, James O.</au><au>Castle, Erik P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Primary robotic RLPND for nonseminomatous germ cell testicular cancer: a two-center analysis of intermediate oncologic and safety outcomes</atitle><jtitle>World journal of urology</jtitle><stitle>World J Urol</stitle><addtitle>World J Urol</addtitle><date>2020-04-01</date><risdate>2020</risdate><volume>38</volume><issue>4</issue><spage>859</spage><epage>867</epage><pages>859-867</pages><issn>0724-4983</issn><eissn>1433-8726</eissn><abstract>Objective
To evaluate the intermediate-term oncologic outcomes and safety profile of the largest case series of primary robotic retroperitoneal lymphadenectomy for low-clinical-stage non-seminomatous germ cell testicular cancer.
Methods
This was a two-center retrospective analysis of robotic RPLND cases for low-clinical-stage (stage I–IIB) non-seminomatous germ cell testicular cancer in the primary setting. Demographic, perioperative, operative and oncologic variables were collected between March 2008 and May 2019. Descriptive analyses were performed and presented as medians with interquartile ranges for continuous variables and frequency and proportions for categorical variables. A survival analysis of time to recurrence was performed using Cox proportional hazards model. Using logistic regression, risk factors for complications were analyzed. Both univariate and multivariate analyses were performed.
Results
A total of 58 patients (CS 1 = 56, CS IIA = 2, CS IIB = 0) were identified. The median follow-up was 47 months and the 2-year recurrence-free survival rate was 91%. The five recurrences were all out of the performed dissection template (pelvis = 1 and lung = 4). Only five patients (29%) with occult metastasis underwent adjuvant chemotherapy. The median operative time was 319 min [interquartile range (IQR) 276–355 min], estimated blood loss was 100 ml (IQR 75–200 ml), node count was 26 (IQR 20–31), and length of stay 2 d (IQR 1–3 days). There were 2 (3.3%) intraoperative complications, 19 (32.7%) 30-day postoperative complications to include 14 (24.1%) Clavien grade I, 4 (6.9%) Clavien grade II, 1 (1.7%) Clavien grade III and 0 Clavien grade IV complications. No statistical significance was found on multivariate or univariate analysis for survival analysis of time to recurrence and risk factors for complications.
Conclusions
This study represents the largest case series of primary R-RPLND for the treatment of low-stage non-seminomatous germ cell tumors (NSGCT). With 47 months of follow-up and a low rate of adjuvant chemotherapy, intermediate oncologic efficacy appears to be comparable to the gold standard open approach.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>31502033</pmid><doi>10.1007/s00345-019-02900-w</doi><tpages>9</tpages></addata></record> |
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| subjects | Adult Cancer Chemotherapy Humans Lymph Node Excision - adverse effects Lymph Node Excision - methods Male Medicine Medicine & Public Health Metastases Neoplasms, Germ Cell and Embryonal - surgery Nephrology Oncology Patients Pelvis Postoperative Complications - epidemiology Postoperative Complications - etiology Retroperitoneal Space Retrospective Studies Risk Factors Robotic Surgical Procedures - adverse effects Robotics Survival analysis Testes Testicular cancer Testicular Neoplasms - surgery Time Factors Topic Paper Treatment Outcome Tumors Urology Young Adult |
| title | Primary robotic RLPND for nonseminomatous germ cell testicular cancer: a two-center analysis of intermediate oncologic and safety outcomes |
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