title: Safety and Early Oncologic Effectiveness of Primary Robotic Retroperitoneal Lymph Node Dissection for Nonseminomatous Germ Cell Testicular Cancer.
abstract: 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).
  
  
  
  To evaluate a multicenter series of primary R-RPLND for low-stage NSGCT.
  
  
  
  Between 2011 and 2015, 47 patients underwent primary R-RPLND at four centers for Clinical Stage (CS) I-IIA NSGCT.
  
  
  
  R-RPLND was performed using the da Vinci surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA).
  
  
  
  Data were collected regarding patient demographics, primary tumor characteristics, pathologic findings, and clinical outcomes.
  
  
  
  Forty-two patients (89%) were CS I and five (11%) were CS IIA. The median operative time was 235min (interquartile range [IQR]: 214-258min), estimated blood loss was 50ml (IQR: 50-100ml), 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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Section of Urology, Department of Surgery, University of Chicago, Chicago, IL, USA. Electronic address: pearce.shane@gmail.com.
authors.forename: Shane M
authors.initials: SM
authors.lastname: Pearce
authors.affiliation: Section of Urology, Department of Surgery, University of Chicago, Chicago, IL, USA.
authors.forename: Shay
authors.initials: S
authors.lastname: Golan
authors.affiliation: Department of Urology, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gorin
authors.affiliation: Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Amy N
authors.initials: AN
authors.lastname: Luckenbaugh
authors.affiliation: Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Williams
authors.affiliation: Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: John F
authors.initials: JF
authors.lastname: Ward
authors.affiliation: Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Montgomery
authors.affiliation: Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Khaled S
authors.initials: KS
authors.lastname: Hafez
authors.affiliation: Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Alon Z
authors.initials: AZ
authors.lastname: Weizer
authors.affiliation: Department of Urology, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Pierorazio
authors.affiliation: Department of Urology, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Mohamad E
authors.initials: ME
authors.lastname: Allaf
authors.affiliation: Section of Urology, Department of Surgery, University of Chicago, Chicago, IL, USA.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Eggener
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D006801:Humans; D007902:Length of Stay; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology / Q000601:surgery*; D061646:Operative Time; D012187:Retroperitoneal Space / Q000601:surgery*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D013736:Testicular Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Complications; Lymph node excision; Nonseminomatous germ cell tumor; Testicular neoplasms; Treatment outcome