Contemporary Perioperative Outcomes of Robotic Retroperitoneal Lymph Node Dissection for Testicular Cancer

Introduction: Robotic retroperitoneal lymph node dissection (R-RPLND) is increasingly recognized as a treatment option for testicular cancer. This study reports contemporary perioperative outcomes from a single institution and examines national trends in R-RPLND adoption. Methods: We retrospectively reviewed patients who underwent R-RPLND at our institution between December 2022 and November 2024. Clinical and perioperative metrics were collected and analyzed using univariable statistical tests. National trends in R-RPLND utilization were assessed using data from the National Cancer Database from 2012 to 2021. Multivariable logistic regression was performed to evaluate factors associated with the use of R-RPLND. Results: At our institution, 31 men underwent R-RPLND. The average length of stay was 1.4 days, and the average estimated blood loss was 60.3 mL. The 30-day complication rate was 3.2%, representing one case of chylous ascites. Nationally, R-RPLND utilization increased from 2.5% in 2012 to 8.3% in 2021. Patients with stages II and III disease were less likely to receive robotic surgery compared to those with stage I disease (odds ratio [OR]: 0.383, 95% confidence interval [CI]: 0.167–0.880, p = 0.024 for stage II; OR: 0.231, 95% CI: 0.098–0.545, p = 0.001 for stage III). No 90-day mortality rate was observed in either cohort. Conclusion: R-RPLND demonstrates favorable perioperative outcomes at both institutional and national levels, with increasing utilization over the past decade. The minimally invasive approach may reduce the morbidity of open surgery and serve as an alternative to chemoradiation in early-stage testicular cancer in selected patients. Further studies are needed to evaluate long-term oncologic outcomes and cost-effectiveness.