Abstract
Background and Purpose:
Postchemotherapy retroperitoneal lymph node dissection (RPLND) remains essential in the management of metastatic testicular carcinoma and represents a surgical challenge. We determined to assess the feasibility and complications of laparoscopic RPLND in patients who were treated with induction chemotherapy for testis cancer.
Patients and Methods:
We performed a retrospective analysis of data that was prospectively recorded from 26 patients who underwent laparoscopic RPLND postplatinum-based chemotherapy between 2000 and 2006. The surgical technique consisted of excision of the residual mass plus unilateral template dissection. A transperitoneal technique was used in 24 patients, and an extraperitoneal approach was used in 2 patients. Operative details, perioperative morbidity data, and histologic findings were assessed for the study.
Results:
Primary pathologic evaluation of the testis tumor revealed pure embryonal carcinoma in 4 patients, teratocarcinoma in 1 patient, and mixed nonseminomatous germ-cell tumors in 21 patients. All patients had residual disease in the retroperitoneum on a preoperative CT scan, with a median size of 3.4 cm (range 2–6 cm). Procedures in three (11.5%) patients were converted to open surgery. Median operative time was 183 minutes (range 120–260 min). Median estimated blood loss was 400 mL (range 100–600 mL), and blood transfusion was necessary in one patient. Median hospital stay was 5 days (range 2–6 d). Median number of lymph nodes obtained on final histologic examination was 7 (range 4–13). Perioperative complications included eight lymphovascular and one intestinal. At a mean follow-up of 27 months (range 14–36 mos), no recurrences have been observed and no patient was lost to follow-up.
Conclusions:
Postchemotherapy laparoscopic RPLND is technically feasible. The most frequent complications and causes of conversion are lymphovascular.
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