Intermediate-term oncological efficacy of laparoscopic retroperitoneal lymph node dissection for non-seminomatous germ cell testicular cancer
ABSTRACT To assess the therapeutic efficacy of laparoscopic retroperitoneal lymph node dissection (L-RPLND) for testicular cancer in patients with nodal disease managed without adjuvant chemotherapy.
Consecutive patients undergoing RPLND were treated laparoscopically. Medical records for 15 patients with pathological stage I and II were reviewed. A modified template dissection was performed laparoscopically. When metastatic disease was noted on intraoperative frozen section, a bilateral template dissection was performed.
All patients had predominantly embryonal carcinoma and/or lymphovascular invasion in their orchidectomy specimen. All patients had normal tumour markers after orchidectomy. Laparoscopic RPLND was performed without intraoperative complications. The mean operative time was 299 min and mean length of hospital stay was 1.5 days. After L-RPLND, two patients were pN1 and five patients were pN2. Of the patients with nodal disease, five (two pN1 and three pN2) were followed without chemotherapy for a mean of 30 months with no evidence of recurrence. Isolated pulmonary recurrence occurred in two patients with pathologic stage I disease, and another stage I patient had recurrence in the lung and retroperitoneum outside the dissection template.
Laparoscopic RPLND appears to be safe while providing the benefits of minimally invasive surgery. Although the therapeutic benefit of L-RPLND needs to be confirmed in additional patients and with longer follow-up, our results suggest that L-RPLND provides both diagnostic and therapeutic benefits.
- [Show abstract] [Hide abstract]
ABSTRACT: The indications to perform primary retroperitoneal lymph node dissection (RPLND) in patients with clinical stage I non-seminomatous germ cell tumors have changed. An initial surgical staging can be justified only for exceptional situations, such as a pure teratoma. Other indications can be the surgical staging and treatment of high risk patients in elective surgery. In this situation, however, only sparse data are available regarding the oncological and therapeutic effect of a minimally invasive approach compared to open surgery. Data are available on the feasibility of laparoscopically performed post-chemotherapy RPLND; however, patients for this approach must be highly selected. In general, robotic-assisted RPLND potentially offers major advantages in terms of safety and oncological efficiency compared to a classical laparoscopic approach. Especially in post-chemotherapy RPLND, the division of lumbar vessels and the control of great vessel lesions may be facilitated. However, only surgeons who are capable of handling a major vessel lesion endoscopically should consider using a robotic-assisted technique. Only patients with relatively small residual tumors without a major involvement of great vessels can be considered as candidates for robotic-assisted post-chemotherapy RPLND.Der Urologe 04/2012; 51(5):687-91. DOI:10.1007/s00120-012-2888-4 · 0.44 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: With increasing adoption of minimally invasive surgical techniques in urologic oncology, the efficacy, safety, and adequacy of lymphadenectomy were reviewed for studies about prostate, bladder, kidney, upper tract urothelial, testicular, and penile cancer published in the past 18 months. In prostate cancer, in which robotic prostatectomy has become the predominant approach, use of extended lymphadenectomy has increased with lymph node yield nearing 20. Minimally invasive lymphadenectomy in bladder cancer does not yet approach the yield seen at high-volume open cystectomy centers, but a larger proportion of robotic lymph node dissections surpass the oncologic threshold of 10-14 lymph nodes compared with open surgery. Comparative lymphadenectomy data for kidney and upper tract urothelial cancers remain muddled as routine lymphadenectomy is not performed and both open and laparoscopic/robotic nephroureterectomy carry no consensus on templates. Minimally invasive retroperitoneal lymph node dissection carries safety and oncologic equivalence to the open technique only in limited centers, whereas minimally invasive ilioinguinal lymphadenectomy for penile cancer remains exploratory at this time. Findings from the prior year suggest that - in high-volume centers - lymph node dissection for urologic cancers is equivalent between open and minimally invasive techniques in lymph node yield and short-term to medium-term oncologic results.Current opinion in urology 01/2013; 23(1):57-64. DOI:10.1097/MOU.0b013e32835af286 · 2.12 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Purpose: Retroperitoneal lymph node dissection (RPLND) is performed in patients with advanced nonseminomatous (NSGCT) germ cell tumors and residual retroperitoneal mass post-chemotherapy. The extent of node dissection remains unclear. Ipsilateral template dissection is a compromise between morbidity and oncological efficacy. Herein, we compare ipsilateral with primary bilateral laparoscopic (L)-RPLND after chemotherapy in terms of morbidity and oncological safety. Patients and methods: Nineteen laparoscopic ipsilateral L-RPLNDs (Group A) after platinum-based chemotherapy in patients with clinical stage IIA-III NSGCT were performed while 20 patients underwent primary bilateral L-RPLND (Group B). We included patients with residuals localized in the retroperitoneum >1 cm and a tumor marker negativity after chemotherapy. The patients in group B had nerve-sparing based on their respective tumor volume. Results: All L-RPLND could successfully be finished without conversion. Mean operative time in group A was 221 minutes and 270 minutes in group B (p=0.12). There were no deviations from the normal postoperative course in 36 cases. There was one Grade II complication (bleomycin-induced pneumonitis) in group A and 1 grade III complication (chylous ascites) in group B. The mean hospitalization time in both groups was 5 days (p=0.1). Regarding the overall rate of disease recurrence no significant difference was found between both groups (HR = 1.84; 95% CI 0.17-39.92; p = 0.6109). Conclusions: Post-chemotherapy L-RPLND remains technically challenging. However, the morbidity of primary bilateral post-chemotherapy L-RPLND is similar to that of template dissection. Additional oncological safety is provided which is particularly relevant in patients with more extensive retroperitoneal tumor volume.Journal of endourology / Endourological Society 03/2013; 27(7). DOI:10.1089/end.2012.0648 · 2.10 Impact Factor