[Retroperitoneal lymphadenectomy in the treatment of testicular germ cell tumors-Is the robot-assisted technique superior to the open surgical approach?]

Abstract

Background: Retroperitoneal lymph node dissection (RPLND) is an established treatment modality for nonseminomatous germ cell tumours (NSGCT) and selected seminomas. The advent of minimally invasive techniques, particularly robot-assisted RPLND (R-RPLND), involves the prospects of reducing procedure-related morbidity while maintaining oncologic efficacy.

Materials and methods: We performed a narrative review comparing contemporary data on R‑RPLND and open RPLND (O-RPLND) across different clinical settings (primary, clinical stages I-II, and postchemotherapy). Guideline recommendations are reviewed regarding results from prospective and retrospective studies, as well as recent meta-analyses.

Results: R‑RPLND consistently demonstrated advantages in perioperative outcomes, including reduced blood loss, shorter length of hospital stay, and faster convalescence. High-grade complication rates (Clavien-Dindo ≥ III) were comparable or lower than with O‑RPLND. Oncologic outcomes, including recurrence-free survival, were noninferior across all stages. In the postchemotherapy setting, R‑RPLND was associated with lower morbidity, though surgical feasibility is highly dependent on tumour size, location, and prior abdominal surgery.

Conclusion: R‑RPLND represents a safe and effective alternative to O‑RPLND in selected patients when performed in high-volume centres. Its perioperative advantages, coupled with equivalent short-term oncologic outcomes, render R‑RPLND an attractive option. However, high-quality randomised trials with long-term follow-up are required to confirm oncologic equivalence and to refine patient selection criteria.