Intermediate‐term oncological efficacy of laparoscopic retroperitoneal lymph node dissection for non‐seminomatous germ cell testicular cancer

Abstract

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Other have reported that laparoscopic RPLND is feasible and safe when performed by skilled laparoscopic surgeons. We show that patients undergoing laparoscopic RPLND do not recur at the site of the lymph node dissection, even when chemotherapy is not given for nodal disease. This shows that laparoscopic RPLND is therapeutically effective in removing tumors that may have spread from the testicle to the retroperitoneum. OBJECTIVE • 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. PATIENTS AND METHODS • 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. RESULTS • 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. CONCLUSIONS • 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.

Comparative effectiveness of minimally invasive versus open lymphadenectomy in urological cancers

“…Within the past 18 months, studies from centers performing minimally invasive RPLND with therapeutic intent (rather than for biopsy or staging) report node counts and intermediate-term recurrence rates replicating open surgical results [67,[70][71][72][73]. Hyams et al [67] report that 91 patients who underwent laparoscopic RPLND had intraoperative complication rates less than 5% and postoperative complication rates less than 10%.…”

Robot‐assisted retroperitoneal lymph node dissection in testicular cancer

“…The management of vascular surgical complication in L‐RPLND was a specific challenge and required superior skills in both laparoscopy and open RPLND in case conversion was necessary. Nevertheless, this procedure evolved with time and series reported longer follow up in larger number of patients where safe oncological outcomes were found while maintaining low morbility and faster recovery from the procedure . For example, Hyams et al reported 3 year follow up of a large single institutional cohort and demonstrated safe oncological outcomes.…”

Comparison of the perioperative outcomes of laparoscopic and open retroperitoneal lymph node dissection for low-stage (stage I/II) testicular germ cell tumors: a systematic review and meta-analysis

“…Although L-RPLND appears to be safe and confers diagnostic and therapeutic benefits to patients, more cases and longer follow-ups are needed to confirm this 14 . Unfortunately, due to patient sample constraints, there are very few studies comparing O-RPLND with L-RPLND for perioperative outcomes in TGCTs 15 .…”