Minimally invasive approach to retroperitoneal lymph node dissection in pediatric paratesticular rhabdomyosarcoma: A multi-institutional case series.

Introduction: Retroperitoneal lymph node dissection (RPLND) is a critical surgical procedure for staging and managing paratesticular rhabdomyosarcoma (RMS) in pediatric patients. While minimally invasive surgical (MIS) approaches, including laparoscopic (LP) and robot-assisted (RA) techniques, are well-documented in adult populations, their utilization in pediatric patients remains limited. This multi-institutional study evaluates perioperative and long-term outcomes of MIS RPLND compared to open RPLND in children with PT-RMS.

Methods: A retrospective analysis was conducted on pediatric patients who underwent RPLND for paratesticular RMS between 2012 and 2024. Data collected included demographics, tumor characteristics, neoadjuvant chemotherapy, operative details, and postoperative outcomes. Descriptive statistics were used to analyze the data.

Results: A total of 16 patients were included in our study (8 MIS and 8 open). The median age of MIS patients was significantly younger (12.6 vs. 15 years, p = 0.03). MIS cases demonstrated shorter operative times (median 436 vs. 590 min, p = 0.03), lower estimated blood loss (35 vs. 200 mL, p = 0.03), and shorter hospital stays (2.5 vs. 6 days, p = 0.01). Lymph node yield was lower in the MIS group (median 13 vs. 26, p = 0.46), but within the COG-recommended range. Both groups had three patients with positive lymph nodes and comparable complication rates. No recurrences were observed in the MIS group over a significantly longer median follow-up period (71.5 vs. 19 months, p = 0.05). Two patients in the open group experienced relapse, including one mortality.

Conclusion: MIS RPLND is a safe and effective surgical option for managing paratesticular RMS in pediatric patients. Wider adoption and further research with larger cohorts are necessary to validate these findings and optimize surgical techniques.