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Tufano A, Cilio S, Spena G, Izzo A, Castaldo L, Grimaldi G, Muscariello R, Franzese D, Quarto G, Autorino R, Passaro F, Perdonà S. Unilateral Post-Chemotherapy Robot-Assisted Retroperitoneal Lymph Node Dissection for Stage II Non-Seminomatous Germ Cell Tumors: Sexual and Reproductive Outcomes. Cancers (Basel) 2024; 16:2231. [PMID: 38927936 PMCID: PMC11201837 DOI: 10.3390/cancers16122231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/05/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
We aimed to report sexual and reproductive outcomes following post-chemotherapy robot-assisted retroperitoneal unilateral lymph node dissection (PC-rRPLND) for non-seminomatous germ cell tumors (NSGCTs) at a high-volume cancer center. We collected records regarding sexual and reproductive outcomes of patients undergoing unilateral PC-rRPLND for stage II NSGCTs from January 2018 to November 2021. Preoperative and postoperative (at 12 months) ejaculatory function as well as erectile function, based on the International Index of Erectile Function-5 (IIEF-5) and Erection Hardness Score (EHS), were assessed. Only patients with a pre-operative IIEF-5 of ≥22 and EHS of ≥3 were included in this analysis. Overall, 22 patients undergoing unilateral PC-rRPLND met the inclusion criteria. Of these, seven (31.8%) patients presented an andrological disorder of any type after PC-rRPLND. Specifically, retrograde ejaculation was present in three (13.6%) patients and hypospermia was present in one (4.5%) patient. Moreover, three (13.6%) patients yielded erectile dysfunction (IIEF-5 < 22 and/or EHS < 3). Lastly, two (9.1%) succeeded in naturally conceiving a child after PC-rRPLND. Retrograde ejaculation is confirmed to be one of the most common complications of PC-rRPLND. Moreover, a non-negligible number of patients experience erectile dysfunction.
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Affiliation(s)
- Antonio Tufano
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy (A.I.); (D.F.); (S.P.)
- Department of Maternal-Infant and Urological Sciences, Policlinico Umberto I Hospital, “Sapienza” Rome University, 00161 Rome, Italy
| | - Simone Cilio
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy
| | - Gianluca Spena
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy (A.I.); (D.F.); (S.P.)
| | - Alessandro Izzo
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy (A.I.); (D.F.); (S.P.)
| | - Luigi Castaldo
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy (A.I.); (D.F.); (S.P.)
| | - Giovanni Grimaldi
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy (A.I.); (D.F.); (S.P.)
| | - Raffaele Muscariello
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy (A.I.); (D.F.); (S.P.)
| | - Dario Franzese
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy (A.I.); (D.F.); (S.P.)
| | - Giuseppe Quarto
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy (A.I.); (D.F.); (S.P.)
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Francesco Passaro
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy
| | - Sisto Perdonà
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy (A.I.); (D.F.); (S.P.)
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Małkiewicz B, Świrkosz G, Lewandowski W, Demska K, Szczepaniak Z, Karwacki J, Krajewski W, Szydełko T. Lymph Node Dissection in Testicular Cancer: The State of the Art and Future Perspectives. Curr Oncol Rep 2024; 26:318-335. [PMID: 38430323 PMCID: PMC11021343 DOI: 10.1007/s11912-024-01511-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE OF REVIEW This narrative review provides a comprehensive overview of the evolving role of retroperitoneal lymph node dissection (RPLND) in the management of testicular cancer (TC). It explores the significance of RPLND as both a diagnostic and therapeutic tool, highlighting its contribution to accurate staging, its impact on oncological outcomes, and its influence on subsequent treatment decisions. RECENT FINDINGS RPLND serves as an essential diagnostic procedure, aiding in the precise assessment of lymph node involvement and guiding personalized treatment strategies. It has demonstrated therapeutic value, particularly in patients with specific risk factors and disease stages, contributing to improved oncological outcomes and survival rates. Recent studies have emphasized the importance of meticulous patient selection and nerve-sparing techniques to mitigate complications while optimizing outcomes. Additionally, modern imaging and surgical approaches have expanded the potential applications of RPLND. In the context of TC management, RPLND remains a valuable and evolving tool. Its dual role in staging and therapy underscores its relevance in contemporary urological practice. This review highlights the critical role of RPLND in enhancing patient care and shaping treatment strategies, emphasizing the need for further research to refine patient selection and surgical techniques.
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Affiliation(s)
- Bartosz Małkiewicz
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland.
| | - Gabriela Świrkosz
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland
| | - Wojciech Lewandowski
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland
| | - Katarzyna Demska
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland
| | - Zuzanna Szczepaniak
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland.
| | - Jakub Karwacki
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland
| | - Wojciech Krajewski
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland
| | - Tomasz Szydełko
- University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland
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Ghoreifi A, Djaladat H. Re: Post-chemotherapy robot-assisted retroperitoneal lymph node dissection for metastatic germ cell tumors: safety and perioperative outcomes. World J Urol. 2023 Jul 28. doi: 10.1007/s00345-023-04536-3. World J Urol 2023; 41:3385-3386. [PMID: 37733090 DOI: 10.1007/s00345-023-04608-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 08/28/2023] [Indexed: 09/22/2023] Open
Affiliation(s)
- Alireza Ghoreifi
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
| | - Hooman Djaladat
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA.
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Lobo J, Acosta AM, Netto GJ. Molecular Biomarkers With Potential Clinical Application in Testicular Cancer. Mod Pathol 2023; 36:100307. [PMID: 37611872 DOI: 10.1016/j.modpat.2023.100307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/28/2023] [Accepted: 08/11/2023] [Indexed: 08/25/2023]
Abstract
Testicular germ cell tumors (TGCTs) and sex cord-stromal tumors (SCSTs) are the most common testicular neoplasms. The morphologic spectrum of such tumors is wide, with several histologic subtypes within each group. Testicular tumors often represent a diagnostic challenge, requiring proper identification of their biologic potential for accurate risk stratification and selection of therapy. In the era of precision medicine, molecular biomarkers are increasingly assuming a critical role in the management of patients with cancer. Given the overall rarity of certain types of testicular neoplasms, progress in biomarker research has been relatively slow. However, in recent years, we have witnessed a multitude of important contributions, including both tissue-based and liquid biopsy biomarkers, stemming from important discoveries of tumor pathobiology, accurate histopathological analysis, multi-institutional studies, and genome-wide molecular analyses of specific tumor subtypes. In this review, we provide an overview of the progress in molecular biomarkers of TGCTs and SCSTs, focusing on those with greatest potential for clinical application. In TGCTs, developmental biology has been the key to understanding these tumors and identifying clinically useful biomarkers (from classical serum tumor markers to pluripotency factors and circulating microRNAs of the 371-373 cluster). For SCSTs, studies have focused on tissue biomarkers only, and genome-wide investigations have recently contributed to a better understanding of rare phenotypes and the aggressive biological behavior of some tumors within this nosologic category. Several new biomarkers are moving toward clinical implementation in this field. Therefore, the practicing pathologist should be aware of their strengths and limitations in order to utilize them properly and maximize their clinical benefits.
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Affiliation(s)
- João Lobo
- Department of Pathology, Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca (P.CCC), Porto, Portugal; Cancer Biology and Epigenetics Group, IPO Porto Research Center (GEBC CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca & RISE@CI-IPOP (Health Research Network), Porto, Portugal; Department of Pathology and Molecular Immunology, ICBAS-School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Andres M Acosta
- Department of Pathology, Indiana University, Indianapolis, Indiana
| | - George J Netto
- Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama.
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Branger N, Bladou F, Verhoest G, Knipper S, Robert G, Bernhard JC, Beauval JB, Khaddad A, Mauger De Varennes A, Fléchon A, Walz J, Bageot AS, Doumerc N, Rouprêt M, Murez T. Post-chemotherapy robot-assisted retroperitoneal lymph node dissection for metastatic germ cell tumors: safety and perioperative outcomes. World J Urol 2023; 41:2405-2411. [PMID: 37507528 DOI: 10.1007/s00345-023-04536-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
PURPOSE To evaluate the feasibility, safety, and early oncologic outcomes after post-chemotherapy robot-assisted retroperitoneal lymph node dissection (PC-RARPLND) for metastatic germ cell tumors (mGCT). METHODS We retrospectively analyzed patients from four tertiary centers who underwent PC-RARPLND for mGCT, from 2011 to 2021. Previous treatment of mGCT, intraoperative and postoperative complications, and early oncologic outcomes were assessed. RESULTS Overall, 66 patients were included. The majority of patients had non-seminoma mTGCT (89%). Median size of retroperitoneal lymph node (RLN) before surgery was 26 mm. Templates of PC-RARPLND were left modified, right modified, and full bilateral in 56%, 27%, and 14%, respectively. Median estimated blood loss and length of stay were 50 mL [50-150] and 2 [1-3] days. Four patients (6.1%) had a vascular injury, only one with significant blood loss and conversion to open surgery (OS). Two other patients had a conversion to OS for difficulty of dissection. No patient had transfusion, most frequent complications were ileus (10.6%) and symptomatic lymphorrea (7.6%) and no complications grade IIIb or more occurred. With a median follow-up of 16 months, two patients had a relapse, all outside of the surgical template (one in the retrocrural space with reascending markers, one in lungs). CONCLUSION PC-RARPLND is a challenging surgery. In expert centers and for selected patients, it seemed safe and feasible, with a low morbidity. Further prospective evaluation of this procedure and long-term oncologic results are needed.
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Affiliation(s)
- Nicolas Branger
- Department of Urology, Institut Paoli Calmettes Cancer Center, Marseille, France.
| | - Franck Bladou
- Department of Urology, CHU Bordeaux, Bordeaux, France
| | | | - Sophie Knipper
- Department of Urology, Institut Paoli Calmettes Cancer Center, Marseille, France
| | | | | | | | | | | | - Aude Fléchon
- Department of Oncology, Centre Léon Bérard, Lyon, France
| | - Jochen Walz
- Department of Urology, Institut Paoli Calmettes Cancer Center, Marseille, France
| | | | | | - Morgan Rouprêt
- Department of Urology, La Pitié Salpêtrière, Paris, France
| | - Thibault Murez
- Department of Urology, CHU Montpellier, Montpellier, France
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Latarius S, Leike S, Erb H, Putz J, Borkowetz A, Thomas C, Baunacke M. Retroperitoneal lymph node dissection for testicular cancer is a demanding procedure: detailed real-life data of complications and additional surgical procedures in 295 cases. World J Urol 2023; 41:2397-2404. [PMID: 37490059 PMCID: PMC10465663 DOI: 10.1007/s00345-023-04516-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/30/2023] [Indexed: 07/26/2023] Open
Abstract
PURPOSE Retroperitoneal lymph node dissection (RPLND) for germ cell tumours is a challenging procedure that may present relevant complications. The purpose was to analyse postoperative complications and identify risk factors for major complications. METHODS This is a retrospective unicentric analysis of a large cohort of 295 RPLNDs from 1992 to 2020. Early complications (30 days) and late complications (31-180 days) were classified according to the Clavien‒Dindo classification. The influence of surgical, patient-specific, and tumour-specific parameters on grade III-V complications was analysed in univariate and multivariate logistic regression models. RESULTS A total of 232 were postchemotherapy RPLNDs, and 63 were primary RPLNDs. Early postoperative complications were found to be grades I-II in 58.6% (173/295), grades III-IV in 9.8% (29/295), and grade V in 0.3% (1/295). In 20% (58/295), additional surgical procedures were needed. Grade III-V complications were associated with ≥ 4 cycles of preoperative chemotherapy (OR 3.7 (1.5-8.9); p = 0.004), RPLND specimen (nonseminoma or immature teratoma) (OR 3.1 (1.4-6.6); p = 0.005), transfusions (OR 2.4 (1.1-5.4); p = 0.03), salvage RPLND (OR 4.1 (1.8-9.3); p < 0.001), and preoperatively elevated AFP (OR 5 (2.2-11.7); p < 0.001). In multivariate analysis, the only independent predictor for grade III-V complications was preoperative AFP elevation (OR 3.3 (1.2-9.2); p = 0.02). Limitations include the retrospective study design. CONCLUSIONS Our results demonstrate that RPLND is a demanding surgical procedure. Patients with a complex tumour history have a higher risk of complications. We recommend treatment of these complex cases in high-volume centres.
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Affiliation(s)
- Stefanie Latarius
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Steffen Leike
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Holger Erb
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Juliane Putz
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Angelika Borkowetz
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Christian Thomas
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Martin Baunacke
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307 Dresden, Germany
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Sigg S, Fankhauser CD. The role of primary retroperitoneal lymph node dissection in the treatment of stage II seminoma. Curr Opin Urol 2023; 33:245-251. [PMID: 37144886 PMCID: PMC10256310 DOI: 10.1097/mou.0000000000001099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE OF REVIEW Stage II seminoma is responsive to chemo- or radiotherapy with a progression-free survival of 87-95% at 5 years but at the cost of short- and long-term toxicity. After evidence about these long-term morbidities emerged, four surgical cohorts investigating the role of retroperitoneal lymph node dissection (RPLND) as a treatment option for stage II disease were initiated. RECENT FINDINGS Currently, two RPLND series have been published as a complete report, while data from other series have only been published as congress abstracts. In series without adjuvant chemotherapy, recurrence rates ranged from 13% to 30% after follow-ups of 21-32 months. In those receiving RPLND and adjuvant chemotherapy, the recurrence rate was 6% after a mean follow-up of 51 months. Across all trials, recurrent disease was treated with systemic chemotherapy (22/25), surgery (2/25), and radiotherapy (1/25). The rate of pN0 disease after RPLND varied between 4% and 19%. Postoperative complications were reported in 2-12%, while antegrade ejaculation was maintained in 88-95% of patients. Median length of stay ranged from 1 to 6 days. SUMMARY In men with clinical stage II seminoma, RPLND is a safe and promising treatment option. Further research is needed to determine the risk of relapse and to personalize treatment options based on patient-specific risk factors.
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Affiliation(s)
- Silvan Sigg
- Department of Urology, Luzerner Kantonsspital, University of Lucerne, Lucerne
| | - Christian Daniel Fankhauser
- Department of Urology, Luzerner Kantonsspital, University of Lucerne, Lucerne
- University of Zurich, Zurich, Switzerland
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Gereta S, Hung M, Hu JC. Robotic-assisted retroperitoneal lymph node dissection for testicular cancer. Curr Opin Urol 2023; 33:274-280. [PMID: 37014761 DOI: 10.1097/mou.0000000000001094] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
PURPOSE OF REVIEW Robotic-assisted retroperitoneal lymph node dissection (R-RPLND) is an emerging surgical option for testicular cancer with less morbidity than open RPLND. We outline the operative technique used at our center and review contemporary evidence in the advancement of R-RPLND. RECENT FINDINGS R-RPLND is being applied effectively beyond clinical stage I testicular cancer to treat low-volume, clinical stage II disease in both the primary and postchemotherapy setting. Compared with the open approach, R-RPLND offers shorter hospitalization and less blood loss with comparably low complications and oncologic control. SUMMARY With ongoing adoption and optimization of R-RPLND, future studies will assess long-term oncologic outcomes and disseminate R-RPLND in the treatment of testicular cancer.
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Affiliation(s)
- Sofia Gereta
- Department of Surgery & Perioperative Care, University of Texas at Austin Dell Medical School, Austin, Texas
| | - Michael Hung
- Department of Urology, New York-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Jim C Hu
- Department of Urology, New York-Presbyterian Weill Cornell Medical Center, New York, New York, USA
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Lin J, Hu Z, Huang S, Shen B, Wang S, Yu J, Wang P, Jin X. Comparison of laparoscopic, robotic, and open retroperitoneal lymph node dissection for non-seminomatous germ cell tumor: a single-center retrospective cohort study. World J Urol 2023; 41:1877-1883. [PMID: 37332060 PMCID: PMC10352171 DOI: 10.1007/s00345-023-04459-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/25/2023] [Indexed: 06/20/2023] Open
Abstract
PURPOSE To compare the perioperative outcomes of L-RPLND, R-RPLND and O-RPLND, and determine which one can be the mainstream option. METHODS We retrospectively reviewed medical records of 47 patients undergoing primary RPLND by three different surgical techniques for stage I-II NSGCT between July 2011 and April 2022 at our center. Standard open and laparoscopic RPLND was performed with usual equipment, and robotic RPLND was operated with da Vinci Si system. RESULTS Forty-seven patients underwent RPLND during 2011-2022, and 26 (55.3%) of them received L-RPLND, 14 (29.8%) were operated with robot, while 7 (14.9%) were performed O-RPLND. The median follow-up was 48.0 months, 48.0 months, and 60.0 months, respectively. The oncological outcomes were comparable among all groups. In L-RPLND group, there were 8 (30.8%) cases of low grade (Clavien I-II) complications, and 3 (11.5%) cases of high-grade (Clavien III-IV) complications. In R-RPLND group, one (7.1%) low-grade complication and four (28.6%) high-grade complications were observed. In O-RPLND group, there were 2 (28.5%) cases of low-grade complications and one case (14.2%) of high-grade one. The operation duration of L-RPLND was the shortest. In O-RPLND group, the number of positive lymph nodes were higher than other two groups. Patients undergoing open surgery had lower (p < 0.05) red blood cell count, hemoglobin level, and higher (p < 0.05) estimated blood loss, white blood cell count than those receiving either laparoscopic or robotic surgery. CONCLUSION All three surgical techniques are comparable in safety, oncological, andrological, and reproductive outcomes under the circumstance of not using primary chemotherapy. L-RPLND might be the most cost-effective option.
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Affiliation(s)
- Juntao Lin
- Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Zhenghui Hu
- Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Shihan Huang
- Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Bohua Shen
- Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Shuo Wang
- Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Jianjun Yu
- Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Ping Wang
- Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, People's Republic of China.
| | - Xiaodong Jin
- Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, People's Republic of China.
- Department of Urology, Zhejiang Provincial Hospital of Chinese Medicine, Zhejiang Chinese Medical University, Hangzhou, 310000, Zhejiang, People's Republic of China.
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Ge S, Gan L, Meng C, Li K, Wang Z, Zeng Z, Zheng L, Li Y. Comparison of the perioperative outcomes of laparoscopic and open retroperitoneal lymph node dissection for low-stage (stage I/II) testicular germ cell tumors: a systematic review and meta-analysis. Int J Surg 2023; 109:995-1005. [PMID: 36917132 PMCID: PMC10389416 DOI: 10.1097/js9.0000000000000321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVE Comparison of the perioperative outcomes of laparoscopic retroperitoneal lymph node dissection (L-RPLND) and open retroperitoneal lymph node dissection (O-RPLND) for low-stage (stage I/II) testicular germ cell tumors. METHODS The authors performed a systematic review and cumulative meta-analysis of the primary outcomes of interest according to PRISMA criteria, and the quality assessment of the included studies followed the AMSTAR guidelines. Four databases were searched, including Embase, PubMed, the Cochrane Library, and Web of Science. The search period was from the creation of each database to October 2022. The statistical analysis software uses Stata17. RESULTS There were nine studies involving 579 patients. Compared with O-RPLND, L-RPLND was associated with shorter length of stay [weighted mean difference (WMD)=-3.99, 95% CI: -4.80 to -3.19, P <0.05], less estimated blood loss (WMD=-0.95, 95% CI: -1.35 to -0.54, P <0.05), shorter time to oral intake after surgery (WMD=-0.77, 95% CI: -1.50 to -0.03, P <0.05), and lower overall complications (odds ratio=0.58, 95% CI: 0.38-0.87, P <0.05). Subgroup analysis found that the complication rate of Clavien-Dindo grade II was lower in L-RPLND (odds ratio=0.24, 95% CI: 0.11-0.55, P <0.05). Interestingly, there was no statistically significant difference between the two groups in terms of operation time, lymph node yields, and recurrence rate during follow-up. CONCLUSION L-RPLND is superior to O-RPLND and is worthy of clinical promotion.
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Affiliation(s)
| | | | | | | | | | | | | | - Yunxiang Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, Sichuan, China
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How Much Chemotherapy Is Required to Optimise Long-term Outcomes in Clinical Stage 2 Seminoma? Eur Urol 2023:S0302-2838(22)02858-5. [PMID: 36609008 DOI: 10.1016/j.eururo.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/14/2022] [Indexed: 01/06/2023]
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Nazzani S, Stagni S, Biasoni D, Catanzaro M, Macchi A, Tesone A, Torelli T, Darisi R, Lo Russo V, Colbacchini C, Lanocita R, Cascella T, Claps M, Giannatempo P, Zimatore M, Cattaneo L, Montanari E, Salvioni R, Nicolai N. Laparoscopic retroperitoneal lymph-node dissection in metastatic nonseminomatous germ-cell tumors. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:257-262. [PMID: 36031470 DOI: 10.1016/j.ejso.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/01/2022] [Accepted: 08/15/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To support laparoscopic post-chemotherapy retroperitoneal lymph-node dissection (L-PC-RPLND) as a potential new standard, we report on a large dataset of patients systematically undergoing L-PC-RPLND. PATIENTS AND METHODS Patients with unilateral residual mass (≥1 cm), normalized markers, limited encasement (<30%) of gross retroperitoneal vessels underwent unilateral L-PC-RPLND with no adjuvant chemotherapy. Surgical performances, histology, hospital stay, complications within 30 days and follow-up visits were recorded. Multivariable linear and logistic regression models were used. RESULTS Between February 2011 and January 2021, 151 consecutive patients underwent L-PC-RPLND. Median size of the residual mass was 25 mm (interquartile range [IQR] 20-35 mm). Overall median operative time was 208 min (IQR 177-241) and was 51 min longer (p-value <0.001) for right L-PC-RPLNDs. Eleven procedures were converted to open surgery. Median number of removed and positive nodes was 11 (IQR 8-16) and 1 (IQR 1-2), respectively. Mean hospital stay was 2 days (IQR 2-3). Nine complications (6%) occurred: two were Clavien-Dindo grade III. Definitive pathology revealed post-pubertal teratoma in 65.6%, fibro-necrotic tissue in 23.8%, teratoma with malignant somatic component in 6.6% and viable tumour in 4.0% patients. In multivariable linear regression models, fibro-necrotic tissue (32 min, CI 8.5-55.5; p < 0.01) and residual volume (1.05 min, CI 0.24-1.85; p < 0.01) achieved independent predictor status for longer operative time. All patients, but one, are alive and disease-free after a median follow-up of 22 months (IQR 10, 48). CONCLUSION L-PC-RPLND, when adequately planned, is safe and effective for most patients with low to medium volume residual masses.
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Affiliation(s)
- Sebastiano Nazzani
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Silvia Stagni
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Davide Biasoni
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mario Catanzaro
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alberto Macchi
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Antonio Tesone
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tullio Torelli
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ruggero Darisi
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Vito Lo Russo
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Claudia Colbacchini
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Università degli Studi di Padova, Italy
| | - Rodolfo Lanocita
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tommaso Cascella
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Melanie Claps
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Patrizia Giannatempo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Matteo Zimatore
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Cattaneo
- Pathology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Roberto Salvioni
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nicola Nicolai
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Testis surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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