Laparoscopic and open postchemotherapy retroperitoneal lymph node dissection in patients with advanced testicular cancer – a single center analysis

Abstract

BackgroundThe open approach represents the gold standard for postchemotherapy retroperitoneal lymph node dissection (O-PCLND) in patients with residual testicular cancer. We analyzed laparoscopic postchemotherapy retroperitoneal lymph node dissection (L-PCLND) and O-PCLND at our institution.MethodsPatients underwent either L-PCLND (n = 43) or O-PCLND (n = 24). Categorical and continuous variables were compared using the Fisher exact test and Mann–Whitney U test respectively. Overall survival was evaluated with the log-rank test.ResultsPrimary histology was embryonal cell carcinomas (18 patients), pure seminoma (2 cases) and mixed NSGCTs (47 patients). According to the IGCCCG patients were categorized into “good”, “intermediate” and “poor prognosis” disease in 55.2%, 14.9% and 20.8%, respectively. Median operative time for L-PCLND was 212 min and 232 min for O-PCLND (p = 0.256). Median postoperative duration of drainage and hospital stay was shorter after L-PCLND (0.0 vs. 3.5 days; p < 0.001 and 6.0 vs. 11.5 days; p = 0.002). Intraoperative complications occurred in 21.7% (L-PCLND) and 38.0% (O-PCLND) of cases with 19.5% and 28.5% of Clavien Grade III complications for L-PCLND and O-PCLND, respectively (p = 0.224). Significant blood loss (>500 ml) was almost equally distributed (8.6% vs. 14.2%: p = 0.076). No significant differences were observed for injuries of major vessels and postoperative complications (p = 0.758; p = 0.370). Tumor recurrence occurred in 8.6% following L-PCLND and in 14.2% following O-PCLND with a mean disease-free survival of 76.6 and 89.2 months, respectively. Overall survival was 83.3 and 95.0 months for L-PCNLD and O-PCLND, respectively (p = 0.447).ConclusionsL-PCLND represents a safe surgical option for well selected patients at an experienced center.

Robot-assisted laparoscopic retroperitoneal lymph node dissection with concomitant inferior vena cava thrombectomy for metastatic mixed testicular germ cell cancer: a case report

“…L-RPLND was first described in 1992 and was initially performed for diagnostic purposes in the post-chemotherapy setting [10]. Since then, L-RPLND has been developed for therapeutic purposes, resulting in similar staging accuracy and oncologic control outcomes as the traditional open technique [11–14]. However, we must face the reality that L-RPLND is technically demanding and requires extensive laparoscopic surgery expertise and an extended learning curve.…”

Guidelines on Testicular Cancer: 2015 Update

“…Mere resection of the residual tumour (so-called lumpectomy) should not be performed [75,77,[79][80][81][82]. Laparoscopic RPLND may yield similar outcomes to the open procedure in very selected cases with small residual disease and in experienced hands, but this strategy is not recommended outside specialised laparoscopic centres with particular expertise in testis tumour management [83][84][85].…”

Laparoscopic Resection of Residual Retroperitoneal Tumor Mass in Advanced Nonseminomatous Testicular Germ Cell Tumors; a Feasible and Safe Oncological Procedure

“…This significant difference is in line with the study by Busch et al . where the RRTM diameter was 22 mm in the L-RRRTM group versus 68 mm in the C-RRRTM group 21 . Para-aortic RRTM location was found significantly more often in the L-RRRTM group than in the C-RRRTM group.…”