目的:比较L-RPLND的围手术期结局,R-RPLND和O-RPLND,并确定哪一个可以成为主流选择。
方法:我们回顾性回顾了2011年7月至2022年4月在我们中心接受I-II期NSGCT三种不同手术技术的原发性RPLND的47例患者的病历。使用常规设备进行标准开放和腹腔镜RPLND,机器人RPLND使用达芬奇Si系统操作。
结果:在2011-2022年期间,47例患者接受了RPLND,其中26例(55.3%)接受了L-RPLND,14人(29.8%)使用机器人操作,7例(14.9%)进行了O-RPLND。中位随访时间为48.0个月,48.0个月,60.0个月,分别。所有组的肿瘤学结果具有可比性。在L-RPLND组中,有8例(30.8%)低级别(ClavienI-II)并发症,和3例(11.5%)高级别(ClavienIII-IV)并发症。在R-RPLND组中,观察到1例(7.1%)低级并发症和4例(28.6%)高级并发症.在O-RPLND组中,低度并发症2例(28.5%),高度并发症1例(14.2%)。L-RPLND的手术时间最短。在O-RPLND组中,阳性淋巴结数量高于其他两组。接受开放手术的患者红细胞计数较低(p<0.05),血红蛋白水平,和更高(p<0.05)的估计失血,白细胞计数比那些接受腹腔镜或机器人手术。
结论:所有三种手术技术在安全性上具有可比性,肿瘤学,雄激素,和生殖结果在不使用主要化疗的情况下。L-RPLND可能是最具成本效益的选择。
OBJECTIVE: 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.
CONCLUSIONS: 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.