Laparoscopic resection of a residual retroperitoneal tumor mass of nonseminomatous testicular germ cell tumors

Abstract

BackgroundResection of a residual retroperitoneal tumor mass (RRRTM) is standard procedure after combination chemotherapy for metastatic nonseminomatous testicular germ cell tumors (NSTGCT).MethodsAt the University Medical Center Groningen, 79 consecutive patients with disseminated NSTGCT were treated with cisplatin combination chemotherapy between 2005 and 2007. Laparoscopic RRRTM was performed for patients with RRTM located less than 5 cm ventrally or laterally from the aorta or the vena cava. The 29 patients who fulfilled the criteria had a median age of 25 years (range, 16–59 years). The stages of disease before chemotherapy treatment according to the Royal Marsden classification were 2A (n = 6, 21%), 2B (n = 14, 48%), 2C (n = 3, 10%), and 4 with a lymph node status of N2 (n = 6, 21%).ResultsThe median duration of laparoscopy was 198 min (range, 122–325 min). The median diameter of the RRTM was 21 mm (range, 11–47 mm). Laparoscopic resection was successful for 25 patients (86%). Conversion was necessary for three patients (10%): two due to bleeding and one because of obesity. One nonplanned hand-assisted procedure (3%) also had to be performed. Histologic examination of the specimens showed fibrosis or necrosis in 12 patients (41%), mature teratoma in 16 patients (55%), and viable tumor in 1 patient (3%). The median hospital stay was 1 day (range, 1–6 days). During a median follow-up period of 47 months (29–70 months), one patient experienced an early relapse (1 month after the end of treatment) (4%).ConclusionFor properly selected patients, laparoscopic resection of RRTM is an improvement in the combined treatment of disseminated NSTGCT and associated with a short hospital stay, minimal morbidity, rapid recovery, and a neat cosmetic result. Long-term data to prove oncologic efficacy are awaited.

Laparoscopic Surgery in Genitourinary Cancer Treatment

“…Laparoscopic retroperitoneal lymph node dissection represents a valuable tool for selected patients with clinical stage I. Further studies should focus on the curative potential of the procedures as well as on the role of post chemotherapy [33,34].…”

“…About 15-20% of stage I (no clinical node metastasis) seminoma and up to 30% of nonseminomatous germ cells cancer patients have subclinical metastases. Surgical resection is the gold standard for managing postchemotherapy residual retroperitoneal tumor mass cases [32,33].…”

“…Laparoscopic surgery in testicular cancer is focused on the treatment of residual retroperitoneal mass or lymph node metastasis after chemotherapy. Retroperitoneal lymph node dissection is still a diagnostic and therapeutic option mainly in stage I disease [34,33].…”

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

“…Laparoscopic surgery is mainly described in literature for stage I disease as a diagnostic procedure and for the resection of low volume disease 13–16 . In an earlier pilot study, the Groningen study group showed that the laparoscopic approach was feasible, with a low rate of retroperitoneal relapse in advanced testicular cancer in properly selected patients 17 . So far, there are no large consecutive series of disseminated testicular cancer patients described with respect to the results of adjunctive surgery; e.g., conventional versus laparoscopic resection of RRTM.…”

Assessment of Volumetric versus Manual Measurement in Disseminated Testicular Cancer; No Difference in Assessment between Non-Radiologists and Genitourinary Radiologist

“…Resection of residual retroperitoneal tumor masses (RRRTM) after chemotherapy is an essential part of the combined therapy of NSTGCT [3,4]. CT of chest and abdomen serve as the main diagnostic tool to determine pre- and post-chemotherapy tumor deposit size, allowing evaluation of the response to treatment and guiding the decision to perform RRRTM, either conventional or via laparoscopic surgery [5]. An alternative approach to surgery can be observing patients after systemic chemotherapy, certainly if abdominal residual tumor masses have become undetectable (lesions < 1 cm) on CT scans and in some institution if the primary tumor did not contain teratoma components [6,7].…”