Matched‐pair analysis of peri‐operative and oncological outcomes of robot‐assisted vs open retroperitoneal lymph node dissection

Objective To analyse a comparatively large cohort of patients who underwent robot‐assisted retroperitoneal lymph node dissection (R‐RPLND) in a single centre, assessing the peri‐operative and oncological safety of this procedure compared to that in a matched‐pair cohort of patients who underwent open retroperitoneal lymph node dissection (O‐RPLND). Methods We retrospectively identified 100 patients who underwent R‐RPLND between October 2010 and January 2024. A matched‐pair analysis of R‐RPLNDs and O‐RPLNDs was conducted based on the following criteria: surgical indication, histology, clinical stage (CS), and tumour size. The primary endpoint of this analysis was progression‐free survival (PFS). Secondary endpoints were peri‐operative parameters. Results Based on surgical indication, the R‐RPLND cohort was divided into four groups: CS II seminoma (Group 1, 42 patients); marker‐negative CS II non‐seminoma (Group 2, 15 patients); CS I non‐seminoma with high‐risk factors (Group 3, seven patients), and post‐chemotherapy patients (Group 4, 34 patients). Two patients were excluded due to uncommon testicular histology. With a mean follow‐up of 32, 31, 32 and 28 months in the four groups, respectively, relapses occurred in 10/42 of Group 1, 3/15 of Group 2, and 1/7 of Group 3, while all patients remained relapse‐free in Group 4. The matched‐pair analysis revealed that histological retroperitoneal lymph node dissection specimens, relapse rates, and PFS were similar in the R‐RPLND and O‐RPLND groups. R‐RPLND had advantages in terms of a shorter hospital stay as a surrogate for less morbidity. Conclusion In selected patients and selected surgical indications, R‐RPLND represents a minimally invasive alternative to O‐RPLND in the management of patients with testicular germ cell tumours.