Christian D Fankhauser1, Luca Afferi2, Sean P Stroup3, Nicholas R Rocco3, Kathleen Olson4, Aditya Bagrodia5, Fady Baky5, Walter Cazzaniga6, Erik Mayer6, David Nicol6, Ekrem Islamoglu7, Stephane de Vergie8, Ragheed Saoud9, Scott E Eggener9, Sebastiano Nazzani10, Nicola Nicolai10, Lee Hugar11, Wade J Sexton11, Deliu-Victor Matei12, Ottavio De Cobelli12, Joseph Cheaib13, Phillip M Pierorazio13, James Porter14, Thomas Hermanns15, Robert J Hamilton16, Andreas Hiester17, Peter Albers17, Noel Clarke18, Agostino Mattei2. 1. Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland. cdfankhauser@gmail.com. 2. Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland. 3. Department of Urology, Naval Medical Center San Diego, San Diego, CA, USA. 4. Department of Urology, Mayo Clinic Hospital, Phoenix, AZ, USA. 5. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. 6. Department of Urology, The Royal Marsden NHS Foundation Trust, London, Sutton, UK. 7. Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey. 8. Department of Urology and Transplantation Surgery, University Hospital Center, Nantes, France. 9. Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA. 10. Department of Urology, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Milano, Italy. 11. Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA. 12. Department of Urology, European Institute of Oncology, Milan, Italy. 13. Department of Urology, The Johns Hopkins Medical Institutions and The James Brady Buchannan Urological Institute, Baltimore, MD, USA. 14. Department of Urology, Department of Urology, University of Washington School of Medicine, Seattle, WA, USA. 15. Department of Urology, University of Zurich, Zurich, Switzerland. 16. Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada. 17. Department of Urology, Medical Faculty, University of Duesseldorf, Heinrich-Heine-University, Duesseldorf, Germany. 18. Department of Urology, The Christie NHS Foundation Trust, Manchester, UK.
Abstract
PURPOSE: To describe the perioperative safety, functional and immediate post-operative oncological outcomes of minimally invasive RPLND (miRPLND) for testis cancer. METHODS: We performed a retrospective multi-centre cohort study on testis cancer patients treated with miRPLND from 16 institutions in eight countries. We measured clinician-reported outcomes stratified by indication. We performed logistic regression to identify predictors for maintained postoperative ejaculatory function. RESULTS: Data for 457 men undergoing miRPLND were studied. miRPLND comprised laparoscopic (n = 56) or robotic (n = 401) miRPLND. Indications included pre-chemotherapy in 305 and post-chemotherapy in 152 men. The median retroperitoneal mass size was 32 mm and operative time 270 min. Intraoperative complications occurred in 20 (4%) and postoperative complications in 26 (6%). In multivariable regression, nerve sparing, and template resection improved ejaculatory function significantly (template vs bilateral resection [odds ratio (OR) 19.4, 95% confidence interval (CI) 6.5-75.6], nerve sparing vs non-nerve sparing [OR 5.9, 95% CI 2.3-16.1]). In 91 men treated with primary RPLND, nerve sparing and template resection, normal postoperative ejaculation was reported in 96%. During a median follow-up of 33 months, relapse was detected in 39 (9%) of which one with port site (< 1%), one with peritoneal recurrence and 10 (2%) with retroperitoneum recurrences. CONCLUSION: The low proportion of complications or peritoneal recurrences and high proportion of men with normal postoperative ejaculatory function supports further miRPLND studies.
PURPOSE: To describe the perioperative safety, functional and immediate post-operative oncological outcomes of minimally invasive RPLND (miRPLND) for testis cancer. METHODS: We performed a retrospective multi-centre cohort study on testis cancer patients treated with miRPLND from 16 institutions in eight countries. We measured clinician-reported outcomes stratified by indication. We performed logistic regression to identify predictors for maintained postoperative ejaculatory function. RESULTS: Data for 457 men undergoing miRPLND were studied. miRPLND comprised laparoscopic (n = 56) or robotic (n = 401) miRPLND. Indications included pre-chemotherapy in 305 and post-chemotherapy in 152 men. The median retroperitoneal mass size was 32 mm and operative time 270 min. Intraoperative complications occurred in 20 (4%) and postoperative complications in 26 (6%). In multivariable regression, nerve sparing, and template resection improved ejaculatory function significantly (template vs bilateral resection [odds ratio (OR) 19.4, 95% confidence interval (CI) 6.5-75.6], nerve sparing vs non-nerve sparing [OR 5.9, 95% CI 2.3-16.1]). In 91 men treated with primary RPLND, nerve sparing and template resection, normal postoperative ejaculation was reported in 96%. During a median follow-up of 33 months, relapse was detected in 39 (9%) of which one with port site (< 1%), one with peritoneal recurrence and 10 (2%) with retroperitoneum recurrences. CONCLUSION: The low proportion of complications or peritoneal recurrences and high proportion of men with normal postoperative ejaculatory function supports further miRPLND studies.
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