Background/Purpose:Retroperitoneal lymph node dissection (RPLND) plays a crucial role in the surgical management of testicular cancer. However, RPLND is associated with a high risk of morbidity. Currently, open RPLND (O-RPLND) is considered the gold standard for surgical treatment. The use of minimally invasive techniques has increased significantly over the last few years. This study aimed to compare the safety and oncological outcomes of open (O-RPLND) and robotic (R-RPLND) retroperitoneal lymph node dissection for testicular cancer.Materials and Methods:We retrospectively analyzed all the patients who underwent RPLND at our testicular cancer center. Standard O-RPLND was performed with the usual equipment, and R-RPLND was performed with the Da Vinci X/Xi surgical system. The pre- and perioperative parameters and the postoperative complications (Clavien–Dindo classification), anejaculation, and the relapse rate were recorded. The association between the clinicopathological variables and the complications and relapse was assessed using regression analyses.Results:Sixty-five patients underwent RPLND during 2017–2024 due to testicular cancer (TC), with thirty-one (47.7%) receiving R-RPLND, including seventeen patients post-chemotherapy (55%). Meanwhile, 34 (52.3%) underwent O-RPLND, comprising 31 patients post-chemotherapy (91%). R-RPLND demonstrated excellent results compared to O-RPLND in terms of the operative time (OT) (p< 0.00001). The R-RPLND group had two (6.5%) high-grade (Clavien–Dindo III–V) complications, while four (11.8%) high-grade complications were noted in the O-RPLND group. R-RPLND was linked to a shorter OT (p< 0.00001). The hospital stay for R-RPLND was, on average, 2.7 days shorter. In logistic regression analysis, R-RPLND was non-inferior to O-RPLND for overall complications (p= 0.6) and low-grade Clavien–Dindo (I-II) (p= 0.2) and high-grade Clavien–Dindo (≥III) complications (p= 0.7). The median follow-up was 13 months for R-RPLND and 38 months for O-RPLND. Two relapses were observed in the R-RPLND group (6.5%), and two in the O-RPLND group (5.9%). One patient who underwent R-RPLND developed field-edge recurrence. No significant differences in the relapse and anejaculation rates were found between R-RPLND and O-RPLND (p= 0.9 andp= 0.8, respectively).Conclusions:In conclusion, R-RPLND is a feasible procedure with a low complication rate and an acceptable oncological outcome. It has proven to be significantly shorter to O-RPLND in relation to the lengths of HS and OT. However, R-RPLND is a demanding procedure with a considerable learning curve.
背景/目的：腹膜后淋巴结清扫术（RPLND）在睾丸癌的外科治疗中具有关键作用，但该手术伴随较高的并发症风险。目前，开放性腹膜后淋巴结清扫术（O-RPLND）被视为外科治疗的金标准。近年来，微创技术的应用显著增加。本研究旨在比较开放性与机器人辅助腹膜后淋巴结清扫术（R-RPLND）在睾丸癌治疗中的安全性及肿瘤学结局。 材料与方法：我们回顾性分析了在本中心睾丸癌中心接受RPLND的所有患者。标准O-RPLND采用常规设备进行，R-RPLND则使用达芬奇X/Xi手术系统。记录术前、围手术期参数及术后并发症（Clavien-Dindo分级）、射精功能障碍和复发率。采用回归分析评估临床病理变量与并发症及复发之间的关联。 结果：2017年至2024年间，共有65例睾丸癌患者接受RPLND，其中31例（47.7%）接受R-RPLND（包括17例化疗后患者，占55%），34例（52.3%）接受O-RPLND（包括31例化疗后患者，占91%）。在手术时间方面，R-RPLND较O-RPLND显著缩短（p<0.00001）。R-RPLND组出现2例（6.5%）高级别（Clavien-Dindo III-V级）并发症，O-RPLND组出现4例（11.8%）。R-RPLND与更短的手术时间相关（p<0.00001），且平均住院时间缩短2.7天。逻辑回归分析显示，在总体并发症（p=0.6）、低级别Clavien-Dindo（I-II级）并发症（p=0.2）及高级别Clavien-Dindo（≥III级）并发症（p=0.7）方面，R-RPLND不劣于O-RPLND。R-RPLND组中位随访时间为13个月，O-RPLND组为38个月。R-RPLND组观察到2例复发（6.5%），O-RPLND组2例（5.9%），其中1例R-RPLND患者出现术野边缘复发。两组在复发率和射精功能障碍率方面均无显著差异（分别为p=0.9和p=0.8）。 结论：综上所述，R-RPLND是一种可行的手术方式，具有较低的并发症发生率和可接受的肿瘤学结局。研究证实其在住院时间和手术时间方面显著短于O-RPLND。然而，R-RPLND作为技术要求较高的术式，存在显著的学习曲线。
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