Societies for Pediatric Urology

SPU Home SPU Home Past & Future Meetings Past & Future Meetings

Back to 2024 Abstracts


A Single-Institution, Retrospective Analysis Of Over Ten Years Of Paratesticular Rhabdomyosarcoma Outcomes After Orchiectomy And Robotic Retroperitoneal Lymph Node Dissection
Venkat M. Ramakrishnan, MD, PhD1, Hatim Thaker, MD1, Andrew A. Wagner, MD2, Richard S. Lee, MD1.
1Boston Children's Hospital, Boston, MA, USA, 2Beth Israel Deaconess Medical Center, Boston, MA, USA.


Background: This retrospective study evaluated surgical outcomes of retroperitoneal (RP) lymph node dissection (RPLND) in patients treated for adolescent paratesticular rhabdomyosarcoma (PT-RMS), focusing on the transition from open to robotic-assisted techniques over the last decade.
Methods: A retrospective chart review was performed for all patients receiving open (O-RPLND) or robotic RPLND (R-RPLND) at Boston Children’s Hospital between 2012 and 2023. The study included patients diagnosed with PT-RMS via orchiectomy. Those with germ- and stromal-cell tumors were excluded. All RPLNDs utilized full bilateral template dissections. Patients presenting with radiologic or surgical evidence of true, consolidated masses were excluded from lymph node (LN) counts.
Results: During the study, eight PT-RMS patients underwent RPLND. The mean age was 15 years at the time of orchiectomy. All patients had normal AFP and β-HCG, 75% (6) had right-sided scrotal lesions, and the average lesion size was 7.2 cm. 62.5% (5) of orchiectomy specimens harbored embryonal RMS, while 12.5% (1) each were alveolar, spindle cell, and uncharacterized RMS subtypes. 25% (2) demonstrated RP metastases on CT, and 12.5% (1) had FDG-avid lesions on PET-CT. The average time from orchiectomy to RPLND was 13.5 days. O-RPLND was performed in 25% (2) of cases due to large tumor burden or anomalous vascular anatomy. The remaining 75% (6) underwent R-RPLND without complications. 25% (2) required pelvic node dissection, and 87.5% (7) received nerve-sparing approaches. LN yields varied; after three patients were excluded per the exclusion criteria, the remaining one O-RPLND yielded 8 LNs and four R-RPLNDs averaged 26.25 LNs. Notably, one patient had a negative pre-operative PET-CT but demonstrated positive LNs pathologically. The average length of stay was 4.25 days, with O-RPLND patients staying 10 days and R-RPLND patients 2.3 days.
Conclusions: R-RPLND yielded higher LN counts and shorter LOS compared to O-RPLND without compromising oncologic needs. Despite the study’s small sample size and retrospective design, our findings suggest that R-RPLND can be effective in managing PT-RMS. Additionally, the discordance between negative PET-CT and pathology in one patient re-emphasizes the need for full template dissection over node sampling. Future studies will investigate long-term ejaculatory outcomes from robotic nerve-sparing techniques.


Back to 2024 Abstracts