{"title":"机器人辅助腹膜后淋巴结清扫术作为精原细胞瘤II期的主要治疗方法。","authors":"Stefano Cogo Badan, Willy Baccaglini, Arie Carneiro, Gustavo Caserta Lemos","doi":"10.1590/S1677-5538.IBJU.2023.0389","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Historically, therapeutic avenues for patients with clinical stage II seminoma germ cell tumors (SGCT) were confined to radiotherapy and chemotherapy. While survival rates with these modalities are commendable, both entail substantial long-term morbidities. Furthermore, this youthful patient cohort exhibits elevated rates of secondary malignancies, surfacing decades post-successful primary cancer treatment (1). Recently, retroperitoneal lymph node dissection (RPLND) has emerged as a primary treatment consideration for individuals with low-volume metastatic seminoma (2-4). However, there is a dearth of video documentation illustrating the robotic assisted (RA) bilateral approach (5- 7).</p><p><strong>Methods: </strong>We present the case of a 24-year-old male who underwent prior left orchiectomy for seminoma (pT1b). Despite negative serum tumor markers, a 1.7 x 1.4cm lymph node enlargement was identified in the aortic bifurcation after 4 months, classifying the patient as stage IIA per the IGCCCG risk classification. Subsequently, a RA bilateral template RPLND was performed due to the patient's refusal of chemotherapy, citing concerns about offspring.</p><p><strong>Results: </strong>The surgery was performed, incorporating nerve sparing techniques, lasting 4h13minutes, an estimated bleeding rate of 400ml, without intraoperative complications. The patient was discharged within 24 hours of the procedure, following a prescribed low-fat diet.</p><p><strong>Conclusion: </strong>The patient experienced postoperative well-being, painlessness, and resumed work three weeks post-procedure. Preserved ejaculation was noted, and adjuvant therapy was performed with 2 cycles of EP due to the anatomopathological result. The feasibility of robotic primary RPLND for SGCT was demonstrated, showing reduced postoperative pain and early hospital discharge. Further studies are necessary to validate our findings regarding oncological, safety, and functional outcomes.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"50 2","pages":"225-226"},"PeriodicalIF":3.1000,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10953600/pdf/","citationCount":"0","resultStr":"{\"title\":\"Robot-assisted retroperitoneal lymph node dissection as primary treatment for stage II seminoma germ cell tumor.\",\"authors\":\"Stefano Cogo Badan, Willy Baccaglini, Arie Carneiro, Gustavo Caserta Lemos\",\"doi\":\"10.1590/S1677-5538.IBJU.2023.0389\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Historically, therapeutic avenues for patients with clinical stage II seminoma germ cell tumors (SGCT) were confined to radiotherapy and chemotherapy. While survival rates with these modalities are commendable, both entail substantial long-term morbidities. Furthermore, this youthful patient cohort exhibits elevated rates of secondary malignancies, surfacing decades post-successful primary cancer treatment (1). Recently, retroperitoneal lymph node dissection (RPLND) has emerged as a primary treatment consideration for individuals with low-volume metastatic seminoma (2-4). However, there is a dearth of video documentation illustrating the robotic assisted (RA) bilateral approach (5- 7).</p><p><strong>Methods: </strong>We present the case of a 24-year-old male who underwent prior left orchiectomy for seminoma (pT1b). Despite negative serum tumor markers, a 1.7 x 1.4cm lymph node enlargement was identified in the aortic bifurcation after 4 months, classifying the patient as stage IIA per the IGCCCG risk classification. Subsequently, a RA bilateral template RPLND was performed due to the patient's refusal of chemotherapy, citing concerns about offspring.</p><p><strong>Results: </strong>The surgery was performed, incorporating nerve sparing techniques, lasting 4h13minutes, an estimated bleeding rate of 400ml, without intraoperative complications. The patient was discharged within 24 hours of the procedure, following a prescribed low-fat diet.</p><p><strong>Conclusion: </strong>The patient experienced postoperative well-being, painlessness, and resumed work three weeks post-procedure. Preserved ejaculation was noted, and adjuvant therapy was performed with 2 cycles of EP due to the anatomopathological result. The feasibility of robotic primary RPLND for SGCT was demonstrated, showing reduced postoperative pain and early hospital discharge. 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引用次数: 0
摘要
简介一直以来,临床 II 期精原细胞瘤(SGCT)患者的治疗手段仅限于放疗和化疗。虽然这些方法的存活率值得称赞,但都会带来大量的长期病痛。此外,这一年轻患者群体的继发性恶性肿瘤发生率较高,在原发性癌症治疗成功后数十年才出现(1)。最近,腹膜后淋巴结清扫术(RPLND)已成为低体积转移性精原细胞瘤患者的主要治疗方法(2-4)。然而,机器人辅助(RA)双侧方法的视频文件却很少(5- 7):我们介绍了一例 24 岁男性的病例,他曾因精索瘤(pT1b)接受过左侧睾丸切除术。尽管血清肿瘤标志物呈阴性,但 4 个月后在主动脉分叉处发现了 1.7 x 1.4 厘米的淋巴结肿大,根据 IGCCCG 风险分类将患者归为 IIA 期。随后,由于患者以担心后代为由拒绝化疗,于是进行了 RA 双侧模板 RPLND:手术采用了神经保护技术,历时 4 小时 13 分钟,出血量估计为 400 毫升,术中无并发症。患者在术后 24 小时内出院,遵医嘱进食低脂饮食:结论:患者术后感觉良好,无痛苦,术后三周即可恢复工作。患者保留了射精功能,由于解剖病理结果,患者接受了两个周期的EP辅助治疗。机器人原发性RPLND治疗SGCT的可行性得到了证实,术后疼痛减轻,出院时间提前。有必要进行进一步研究,以验证我们在肿瘤学、安全性和功能性结果方面的发现。
Robot-assisted retroperitoneal lymph node dissection as primary treatment for stage II seminoma germ cell tumor.
Introduction: Historically, therapeutic avenues for patients with clinical stage II seminoma germ cell tumors (SGCT) were confined to radiotherapy and chemotherapy. While survival rates with these modalities are commendable, both entail substantial long-term morbidities. Furthermore, this youthful patient cohort exhibits elevated rates of secondary malignancies, surfacing decades post-successful primary cancer treatment (1). Recently, retroperitoneal lymph node dissection (RPLND) has emerged as a primary treatment consideration for individuals with low-volume metastatic seminoma (2-4). However, there is a dearth of video documentation illustrating the robotic assisted (RA) bilateral approach (5- 7).
Methods: We present the case of a 24-year-old male who underwent prior left orchiectomy for seminoma (pT1b). Despite negative serum tumor markers, a 1.7 x 1.4cm lymph node enlargement was identified in the aortic bifurcation after 4 months, classifying the patient as stage IIA per the IGCCCG risk classification. Subsequently, a RA bilateral template RPLND was performed due to the patient's refusal of chemotherapy, citing concerns about offspring.
Results: The surgery was performed, incorporating nerve sparing techniques, lasting 4h13minutes, an estimated bleeding rate of 400ml, without intraoperative complications. The patient was discharged within 24 hours of the procedure, following a prescribed low-fat diet.
Conclusion: The patient experienced postoperative well-being, painlessness, and resumed work three weeks post-procedure. Preserved ejaculation was noted, and adjuvant therapy was performed with 2 cycles of EP due to the anatomopathological result. The feasibility of robotic primary RPLND for SGCT was demonstrated, showing reduced postoperative pain and early hospital discharge. Further studies are necessary to validate our findings regarding oncological, safety, and functional outcomes.