Robotic versus open post-chemotherapy retroperitoneal lymph node dissection: a propensity score matched study across 11 academic medical centers.

OBJECTIVES: To compare perioperative and survival outcomes of patients undergoing robotic versus open post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) for testicular cancer. MATERIALS AND METHODS: Analyzing data from patients who underwent PC-RPLND at eleven academic centres between 1990 and 2023, we used propensity score matching (PSM) to create a 1:1 (open-RPLND: robotic-RPLND) matched cohort. The primary endpoint was time to relapse. Secondary endpoints included operative time, length of stay, estimated blood loss, and surgical complications. Relapse free survival rates were calculated using the Kaplan-Meier methodology, and Cox proportional hazards model was used to compare perioperative outcomes between robotic vs. open PC-RPLND after adjusting for template and pathology. RESULTS: A total of 134 robotic cases were propensity score matched to 134 open cases. At a median follow-up of 2.2 years, estimated relapse-free survival at 3 years was similar between robotic and open PC-RPLND (92.8% vs. 88.5%, p = 0.18). Relapse occurred in 5.2% (robotic) vs. 12.3% (open), with most relapses occurring within the first year. Robotic PC-RPLND was associated with lower blood loss, length of hospital stay, and fewer complications (16.4% vs. 32.1%), including a 0% rate of ileus compared to 12.7% in the open group. Lymph node yield and rates of viable tumor were comparable between approaches. The main limitation of this study was its retrospective nature. CONCLUSION: This is the first multicenter study to compare open versus robotic PC-RPLND using a PSM system. With appropriate patient selection and surgical experience at academic centers specializing in testicular cancer care, robotic PC-RPLND offers low morbidity and improved perioperative outcomes while maintaining the similar oncological outcomes, compared to the open approach.