A systematic review of open versus robotic retroperitoneal lymph node dissection for testicular cancer: Comparative operative and oncological outcomes

Open retroperitoneal lymph node dissection (RPLND) is the gold-standard surgical approach for the management of metastatic testicular cancer, but robotic RPLND is becoming increasingly popular. There is limited research directly comparing open and robotic RPLND. The objective of this systematic review is to identify all the literature with direct comparisons between the open and robotic techniques for RPLND and to compare the two techniques. The primary outcome was peri-operative outcomes, and the secondary outcomes included oncological outcomes and patient demographics. This systematic review was prospectively registered (PROSPERO ID: CRD42024591616) and was conducted in accordance with the PRISMA statement. The PubMed, Embase and MEDLINE databases were searched for relevant publication from January 2006 to August 2024. Eight studies, totaling 3995 patients, are included in this systematic review, with 3521 patients who underwent open RPLND and 474 who underwent robotic RPLND. For open RPLND, the mean operative duration, blood loss and length of stay were 267.8 min, 475 mL and 7.3 d, respectively. For robotic RPLND, the mean operative duration, blood loss and length of stay were 334.5 min, 94.6 mL and 3.7 d, respectively. Teratoma was the most common RPLND specimen pathology from both open and robotic surgeries. For open RPLND, the specimens have 13–23 nodes (26–32 mm), whereas the robotic RPLND specimens have 13–28 nodes (18–20 mm). This systematic review suggests that the benefits of robotic RPLND may be associated with reduced blood loss, shorter hospitalisation and an overall lower risk of minor and major complications while maintaining oncological safety.