Clinical outcome of robot-assisted residual mass resection in metastatic nonseminomatous germ cell tumor
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ORIGINAL ARTICLE
Clinical outcome of robot‑assisted residual mass resection in metastatic nonseminomatous germ cell tumor Joost M. Blok1,2 · Henk G. van der Poel2 · J. Martijn Kerst3 · Axel Bex2 · Oscar R. Brouwer2 · J. L. H. Ruud Bosch1 · Simon Horenblas2 · Richard P. Meijer1 Received: 20 July 2020 / Accepted: 31 August 2020 © The Author(s) 2020
Abstract Purpose To evaluate the outcome of robot-assisted residual mass resection (RA-RMR) in nonseminomatous germ cell tumor (NSGCT) patients with residual tumor following chemotherapy. Patients and methods Retrospective medical chart analysis of all patients with NSGCT undergoing RA-RMR at two tertiary referral centers between January 2007 and April 2019. Patients were considered for RA-RMR in case of a residual tumor between 10 and 50 mm at cross-sectional computed tomography (CT) imaging located ventrally or laterally from the aorta or vena cava, with normalized tumor markers following completion of chemotherapy, and no history of retroperitoneal surgery. Results A total of 45 patients were included in the analysis. The Royal Marsden stage before chemotherapy was IIA in 13 (28.9%), IIB in 16 (35.6%), IIC in 3 (6.7%) and IV in 13 patients (28.9%). The median residual tumor size was 1.9 cm (interquartile range [IQR] 1.4–2.8; range 1.0–5.0). Five procedures (11.1%) were converted to an open procedure due to a vascular injury (n = 2), technical difficulty (n = 2) or tumor debris leakage (n = 1). A postoperative adverse event occurred in two patients (4.4%). Histopathology showed teratoma, necrosis and viable cancer in 29 (64.4%), 14 (31.1%), and two patients (4.4%), respectively. After a median follow-up of 41 months (IQR 22–70), one patient (2.2%) relapsed in the retroperitoneum. The one- and 2-year recurrence-free survival rate was 98%. Conclusion RA-RMR is an appropriate treatment option in selected patients, potentially providing excellent cure rates with minimal morbidity. Long-term outcome data are needed to further support this strategy and determine inclusion and exclusion criteria. Keywords Nonseminomatous germ cell tumor · Retroperitoneal lymph node dissection · Robot-assisted retroperitoneal lymph node dissection · Robotic surgery · Testicular cancer · Testicular germ cell tumor
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00345-020-03437-z) contains supplementary material, which is available to authorized users. * Joost M. Blok j.m.blok‑[email protected] * Richard P. Meijer [email protected] 1
Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
2
Department of Urology, The Netherlands Cancer Institute, Utrecht, The Netherlands
3
Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
Abbreviations CT Computerized tomography IGCCCG International Germ Cell Cancer Collaborative Group IQR Interquartile range MSKCC Memorial Sloan Kettering Cancer Center NSGCT Nonseminomatous germ cell tumor TGC
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