Robotic retroperitoneal lymph node dissection for primary and post-chemotherapy testis cancer
Robotic retroperitoneal lymph node dissection for primary and post-chemotherapy testis cancer
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DOI：
10.1007/s11701-021-01252-1
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发表时间：
2021-05-12
影响因子：
2.3
通讯作者：
Hamilton, R. J.
中科院分区：
文献类型：
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作者：
Nason, G. J.;Kuhathaas, K.;Hamilton, R. J.
腹膜后淋巴结清扫（RPLND）在原发性和化疗后睾丸癌中的作用已经得到了很好的证实。本研究的目的是报告机器人RPLND的2年肿瘤学结果。在玛格丽特公主癌症中心，由一名外科医生对所有接受机器人RPLND的患者进行回顾性研究。人口统计学、围手术期和肿瘤学数据采用描述性统计进行分析。2014年9月至2020年6月期间，141例患者接受了RPLND[33例（23.4%）为原发性，108例（76.6%）为化疗后]。27例（19.1%）患者接受了机器人双侧模板保神经RPLND。18例（66.7%）患者的RPLND指征为原发性（即化疗前），9例（33.3%）患者为化疗后。RPLND分期为2A （n = 15, 55.6%）、2B （n = 9, 33.3%）、2C （n = 1, 3.7%）和3 （n = 2, 7.4%）。中位手术时间（切口至闭合）为525 min，出血量为200 ml。除1例外，其余病例均行神经保留。6例（22.2%）辅助手术包括2例（7.4%）血管修复。中位住院时间为2天。存活肿瘤17例（63%），畸胎瘤9例（33.3%）。中位随访时间为31.3个月。未给予辅助化疗。3例（11.1%）复发：2例野区外病变，1例野区内外病变均复发。机器人RPLND可以安全地进行。像我们这样的长期随访系列，包括有存活的疾病和/或畸胎瘤的患者，并且不接受辅助化疗，以确保肿瘤结果与开放方法相当。
The role of retroperitoneal lymph node dissection (RPLND) in testicular cancer is well established in both the primary and post-chemotherapy setting. The aim of this study was to report our 2 years oncological outcomes of robotic RPLND. A retrospective review was performed of all patients undergoing robotic RPLND by a single surgeon at Princess Margaret Cancer Centre. Demographic, perioperative, and oncologic data were analyzed using descriptive statistics. Between September 2014 and June 2020, 141 patients underwent an RPLND [33 (23.4%) were primary, 108 (76.6%) were post-chemotherapy]. 27 (19.1%) patients underwent a robotic bilateral template nerve-sparing RPLND. RPLND indication was primary (i.e. pre-chemotherapy) in 18 (66.7%), and post-chemotherapy in 9 (33.3%) patients. Stage at RPLND was 2A (n = 15, 55.6%), 2B (n = 9, 33.3%), 2C (n = 1, 3.7%) and 3 (n = 2, 7.4%). Median OR time (incision to closure) was 525 min and blood loss was 200 ml. Nerve sparing was performed in all but one case. Six (22.2%) adjuvant procedures were performed including two (7.4%) vascular repairs. Median length of stay was 2 days. Viable tumor was detected in 17 (63%) and teratoma in 9 (33.3%). Median follow-up was 31.3 months. No adjuvant chemotherapy was given. Three patients (11.1%) relapsed: 2 out-of-field and 1 with both in-field and out-of-field disease. Robotic RPLND can be performed safely. Long-term follow-up of series such as ours, enriched with patients with viable disease and/or teratoma, and not treated with adjuvant chemotherapy is required to ensure oncological outcomes are comparable to the open approach.