Eur J Surg Oncol. 2025 Jun 24;51(8):110281. doi: 10.1016/j.ejso.2025.110281. Online ahead of print.
ABSTRACT
INTRODUCTION: Retroperitoneal lymph node dissection (RPLND) is an integral part of the multidisciplinary treatment of Testis cancer (TC). Up to now, only few studies compared traditional open RPLND (O-RPLND) with minimally invasive approach. We investigated surgical outcomes and complication rates of patient with TC treated with O-RPLND or robot assisted (RA-RPLND).
MATERIALS AND METHODS: We performed a retrospective analysis of all consecutive patients who underwent RPLND for TC, between 2001 and 2023. We recorded Patient demographics, perioperative and post-operative data. Descriptive statistics depicted differences between O-RPLND and RA-RPLND. Multivariable Poisson regression models (MPRMs) tested for predictors of surgical drain permanence, NSAIDs use (days), LOS, EBL and OT. Multivariable logistic regression models (MLRM) tested for of post operative complications.
RESULTS: Of 144 patients who underwent RPLND, 53 (36.4 %) were treated with RA-RPLND and 91 (63.6 %) with O-RPLND. RA-RPLND group had significantly lower median EBL (50 ml vs 150 ml in O- RPLND; p < 0.01), median LOS (4 days vs 5.5 days in O-RPLND; p < 0.01), median drain indwelling days (4 vs 5 in O-RPLND; p = 0.03), Hb drop (1.5 g/dl vs 1.9 g/dl; p = 0.02) and median NSAIDs use (1 day vs 3 days in O-RPLND; p < 0.01). No difference in intra- and postoperative complication rates was recorded. In MPRM, RA-RPLND was associated with shorter LOS (RR:0.28; p < 0.01), drain permanence time (RR: 0.83; p = 0.01), NSAIDs use (RR:0.63; p < 0.01), and OT (RR 0.85; p < 0.01).
CONCLUSION: RA-RPLND appears to lead to shorter LOS and permanence of surgical drain, lower need for painkillers, lower blood loss and lower OT to O-RPLND, but does not seem associated with lower complication rates compared to O-RPLND. Our findings require prospective validation in future randomized trials.
PMID:40587911 | DOI:10.1016/j.ejso.2025.110281
