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Robot-assisted post-chemotherapy retroperitoneal lymph node dissection in germ cell tumor: is the single-docking with lateral approach relevant?

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Abstract

Introduction

Surgical treatment of post-chemotherapy residual mass of germ cell tumor (GCT) may be performed in various techniques. We assess the feasibility, safety, and efficacy of single-docking with lateral approach robot-assisted retroperitoneal lymph node dissection (R-RPLND) in residual mass of GCT in our center.

Materials and methods

A retrospective review of patients undergoing R-RPLND for residual mass of CGT was performed between January 2014 and April 2017. Patients with residual mass < 3 cm for seminoma or < 1 cm for non-seminoma were eligible. All surgeries were performed with single-docking RPNLD technique in lateral decubitus. We assessed preoperative characteristics (age, testicular pathology, template, chemotherapy regimen, lesion size, and clinical stage), peroperative (operative time, estimated blood loss, intraoperative complication, node count, pathology, and number of positive node), and postoperative outcomes (postoperative complications, hospital length of stay, recurrence-free survival at 2 year, and ejaculation dysfunction).

Results

Eleven patients underwent R-RPLND with a median size of the residual mass of 20 mm. Median operative time was 153 min with 120 ml of estimated blood loss, without intraoperative complication. Median nodes count was 7 [1; 24]. Two patients had post-chemotherapy necrotic nodes and one no tumorous node. One patient had postoperative Clavien I complication (chyloperitoneum). We report 72.7% of antegrade ejaculation at 1 month from the surgery. Median clinical recurrence-free survival was 100% after 2 years from the surgery (n = 6).

Conclusion

Lateral approach with single-docking R-RPLND for residual mass of GCT is feasible and safe, with satisfying functional and oncologic outcomes.

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Authors and Affiliations

  1. Department of Urology, Andrology and Renal Transplantation, CHU Grenoble, La Tronche, France

    C. Overs

  2. Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, 1, Av J Pouilhès, 31059, Toulouse Cedex, France

    J. B. Beauval, L. Mourey, P. Rischmann, M. Soulié, M. Roumiguié & Nicolas Doumerc

  3. Oncology Department, Cancer Institute of Toulouse (IUCT-O), Toulouse, France

    L. Mourey & M. Roumiguié

Authors
  1. C. Overs
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  2. J. B. Beauval
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  3. L. Mourey
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  4. P. Rischmann
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  5. M. Soulié
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  6. M. Roumiguié
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  7. Nicolas Doumerc
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Contributions

CO: data collection and management, data analysis, and manuscript writing. JBB: project development, data analysis, and manuscript writing. LM: project development. PR: project development. MS: project development. MR: project development, data management, and data analysis. ND: project development, data collection or management, and data analysis

Corresponding author

Correspondence to Nicolas Doumerc.

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Conflict of interest

Nicolas Doumerc is a consultant for intuitive surgical.

Research involving human participants

Yes.

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Not concerned (retrospective study).

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Overs, C., Beauval, J.B., Mourey, L. et al. Robot-assisted post-chemotherapy retroperitoneal lymph node dissection in germ cell tumor: is the single-docking with lateral approach relevant?. World J Urol 36, 655–661 (2018). https://doi.org/10.1007/s00345-018-2177-y

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  • DOI: https://doi.org/10.1007/s00345-018-2177-y

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