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.