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Abstract：
OBJECTIVE: To evaluate the intermediate-term oncologic outcomes and safety profile of the largest case series of primary robotic retroperitoneal lymphadenectomy for low-clinical-stage non-seminomatous germ cell testicular cancer.
METHODS: This was a two-center retrospective analysis of robotic RPLND cases for low-clinical-stage (stage I-IIB) non-seminomatous germ cell testicular cancer in the primary setting. Demographic, perioperative, operative and oncologic variables were collected between March 2008 and May 2019. Descriptive analyses were performed and presented as medians with interquartile ranges for continuous variables and frequency and proportions for categorical variables. A survival analysis of time to recurrence was performed using Cox proportional hazards model. Using logistic regression, risk factors for complications were analyzed. Both univariate and multivariate analyses were performed.
RESULTS: A total of 58 patients (CS 1 = 56, CS IIA = 2, CS IIB = 0) were identified. The median follow-up was 47 months and the 2-year recurrence-free survival rate was 91%. The five recurrences were all out of the performed dissection template (pelvis = 1 and lung = 4). Only five patients (29%) with occult metastasis underwent adjuvant chemotherapy. The median operative time was 319 min [interquartile range (IQR) 276-355 min], estimated blood loss was 100 ml (IQR 75-200 ml), node count was 26 (IQR 20-31), and length of stay 2 d (IQR 1-3 days). There were 2 (3.3%) intraoperative complications, 19 (32.7%) 30-day postoperative complications to include 14 (24.1%) Clavien grade I, 4 (6.9%) Clavien grade II, 1 (1.7%) Clavien grade III and 0 Clavien grade IV complications. No statistical significance was found on multivariate or univariate analysis for survival analysis of time to recurrence and risk factors for complications.
CONCLUSIONS: This study represents the largest case series of primary R-RPLND for the treatment of low-stage non-seminomatous germ cell tumors (NSGCT). With 47 months of follow-up and a low rate of adjuvant chemotherapy, intermediate oncologic efficacy appears to be comparable to the gold standard open approach.
METHODS: This was a two-center retrospective analysis of robotic RPLND cases for low-clinical-stage (stage I-IIB) non-seminomatous germ cell testicular cancer in the primary setting. Demographic, perioperative, operative and oncologic variables were collected between March 2008 and May 2019. Descriptive analyses were performed and presented as medians with interquartile ranges for continuous variables and frequency and proportions for categorical variables. A survival analysis of time to recurrence was performed using Cox proportional hazards model. Using logistic regression, risk factors for complications were analyzed. Both univariate and multivariate analyses were performed.
RESULTS: A total of 58 patients (CS 1 = 56, CS IIA = 2, CS IIB = 0) were identified. The median follow-up was 47 months and the 2-year recurrence-free survival rate was 91%. The five recurrences were all out of the performed dissection template (pelvis = 1 and lung = 4). Only five patients (29%) with occult metastasis underwent adjuvant chemotherapy. The median operative time was 319 min [interquartile range (IQR) 276-355 min], estimated blood loss was 100 ml (IQR 75-200 ml), node count was 26 (IQR 20-31), and length of stay 2 d (IQR 1-3 days). There were 2 (3.3%) intraoperative complications, 19 (32.7%) 30-day postoperative complications to include 14 (24.1%) Clavien grade I, 4 (6.9%) Clavien grade II, 1 (1.7%) Clavien grade III and 0 Clavien grade IV complications. No statistical significance was found on multivariate or univariate analysis for survival analysis of time to recurrence and risk factors for complications.
CONCLUSIONS: This study represents the largest case series of primary R-RPLND for the treatment of low-stage non-seminomatous germ cell tumors (NSGCT). With 47 months of follow-up and a low rate of adjuvant chemotherapy, intermediate oncologic efficacy appears to be comparable to the gold standard open approach.
摘要：
目的：评估大型机器人腹膜后淋巴结清扫术治疗低临床分期非精原细胞生殖细胞睾丸癌的中期肿瘤学结果和安全性。
方法：这是对初级设置的低临床分期（I-IIB期）非精原细胞生殖细胞睾丸癌机器人RPLND病例的两中心回顾性分析。人口统计,围手术期,收集了2008年3月至2019年5月期间的手术和肿瘤变量.进行了描述性分析，并以中位数表示连续变量的四分位数范围以及分类变量的频率和比例。使用Cox比例风险模型对复发时间进行生存分析。使用逻辑回归，分析并发症的危险因素。进行了单变量和多变量分析。
结果：共确定58例患者（CS1=56，CSIIA=2，CSIIB=0）。中位随访时间为47个月，2年无复发生存率为91%。五次复发均不属于所进行的解剖模板（骨盆=1，肺=4）。只有5例（29％）隐匿性转移患者接受了辅助化疗。中位手术时间为319分钟[四分位距（IQR）276-355分钟]，估计失血量为100毫升（IQR75-200毫升），节点计数为26(IQR20-31)，和住院时间2天（IQR1-3天）。术中并发症2例（3.3%），19（32.7％）30天术后并发症，包括14（24.1％）ClavienI级，4（6.9%）Clavien二级，1例（1.7％）ClavienIII级和0ClavienIV级并发症。对于复发时间和并发症危险因素的生存分析，在多变量或单变量分析中没有发现统计学意义。
结论：本研究代表了原发性R-RPLND治疗低期非精原细胞生殖细胞肿瘤（NSGCT）的最大病例系列。随访47个月，辅助化疗率较低，中等肿瘤疗效似乎与黄金标准开放方法相当。
方法：这是对初级设置的低临床分期（I-IIB期）非精原细胞生殖细胞睾丸癌机器人RPLND病例的两中心回顾性分析。人口统计,围手术期,收集了2008年3月至2019年5月期间的手术和肿瘤变量.进行了描述性分析，并以中位数表示连续变量的四分位数范围以及分类变量的频率和比例。使用Cox比例风险模型对复发时间进行生存分析。使用逻辑回归，分析并发症的危险因素。进行了单变量和多变量分析。
结果：共确定58例患者（CS1=56，CSIIA=2，CSIIB=0）。中位随访时间为47个月，2年无复发生存率为91%。五次复发均不属于所进行的解剖模板（骨盆=1，肺=4）。只有5例（29％）隐匿性转移患者接受了辅助化疗。中位手术时间为319分钟[四分位距（IQR）276-355分钟]，估计失血量为100毫升（IQR75-200毫升），节点计数为26(IQR20-31)，和住院时间2天（IQR1-3天）。术中并发症2例（3.3%），19（32.7％）30天术后并发症，包括14（24.1％）ClavienI级，4（6.9%）Clavien二级，1例（1.7％）ClavienIII级和0ClavienIV级并发症。对于复发时间和并发症危险因素的生存分析，在多变量或单变量分析中没有发现统计学意义。
结论：本研究代表了原发性R-RPLND治疗低期非精原细胞生殖细胞肿瘤（NSGCT）的最大病例系列。随访47个月，辅助化疗率较低，中等肿瘤疗效似乎与黄金标准开放方法相当。
