Comparative perioperative and early oncologic outcomes of robot-assisted versus open retroperitoneal lymph node dissection in testicular germ cell tumors-experience from a tertiary Latin American referral center

OBJECTIVE: To compare perioperative and early oncologic outcomes between open and robot-assisted retroperitoneal lymph node dissection (RPLND) for testicular germ cell tumors in a tertiary referral center in Latin America. PATIENTS AND METHODS: We retrospectively analyzed a prospectively maintained database of consecutive patients undergoing RPLND between January 2020 and December 2025. Patients treated with open or robot-assisted RPLND were included; laparoscopic cases were excluded. Baseline characteristics, perioperative outcomes, and oncologic outcomes were collected. To address baseline imbalances, 1:1 propensity score matching (PSM) was performed using clinically relevant preoperative covariates. Perioperative outcomes included operative time, estimated blood loss (EBL), length of stay (LOS), transfusion, ICU admission, complications, and readmission. Recurrence-free survival (RFS) and overall survival (OS) were assessed using Kaplan-Meier analysis. RESULTS: A total of 66 patients were included (28 open, 38 robotic). After PSM, 20 well-matched pairs were analyzed. In the matched cohort, robot-assisted RPLND was associated with lower EBL (median 100 vs 200 mL, p = 0.01) and shorter LOS (median 1.0 vs 2.0 days, p < 0.001) compared with open RPLND. Operative time was similar between approaches (median 240 min, p = 0.39). Rates of transfusion, ICU admission, overall complications, major complications (Clavien-Dindo ≥3), and 30- and 90-day readmission did not differ significantly between groups. With follow-up censored at 21 December 2025, RFS and OS were comparable between open and robotic RPLND (log-rank p > 0.05 for both). CONCLUSIONS: In this contemporary cohort from a tertiary referral center in Latin America, robot-assisted RPLND was associated with reduced blood loss and shorter hospitalization, without differences in perioperative safety or early oncologic outcomes in comparison to open access. These findings support the feasibility of robotic RPLND as a perioperatively efficient surgical approach when performed in experienced centers.