Laparoscopic Retroperitoneal Lymph Node Dissection for Clinical Stage I Nonseminomatous Germ Cell Tumors of the Testis: Safety and Efficacy Analyses at a High Volume Center

Nicolai, Nicola; Tarabelloni, Nicholas; Gasperoni, Francesca; Catanzaro, Mario; Stagni, Silvia; Torelli, Tullio; Tesone, A.; Bettin, L.; Necchi, Andrea; Giannatempo, Patrizia; Raggi, Daniele; Colecchia, Maurizio; Piva, Luigi; Salvioni, Roberto; Paganoni, Anna Maria; Pizzocaro, Giorgio; Biasoni, Davide

doi:10.1016/j.juro.2017.09.088

Cited by 22 publications

(18 citation statements)

References 26 publications

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“…Retroperitoneal lymph node dissection (RPLND) is recommended for nonseminomatous germ cell tumors (NSGCTs) with a residual mass of over 1 cm after chemotherapy on radiographic imaging according to the European Association of Urology (EAU) guidelines. Previous studies of laparoscopic RPLND (L-RPLND) have shown feasibility but difficulty because of perinodal and perivessel fibrosis and adhesions [2, 3]. Robot-assisted L-RPLND (R-RPLND) has proven its advantages with regard to high-definition three-dimensional visualization, increased freedom of instrument movement, and minimization of tremors.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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Background The robot-assisted laparoscopic management of post-chemotherapy retroperitoneal metastasis and inferior vena cava tumor thrombus secondary to testicular cancer is a challenging task for urologists. Case presentation A pathological examination of a 36-year-old Caucasian man who had undergone a right radical orchiectomy showed mixed testicular germ cell cancer (70% embryonal cancer and 30% seminoma); he had undergone four prior courses of cisplatin, etoposide, and bleomycin chemotherapy and was found to have residual retroperitoneal enlarged lymph nodes close to the right renal hilum and a 9.8 cm inferior vena cava tumor thrombus (pT1, N2, M1, S2). Pre-surgical three-dimensional image reconstruction was performed based on contrast computed tomography data. The inferior vena cava tumor thrombus was found in the vena cava at the level of the celiac trunk and the inferior mesenteric artery. Our patient accepted treatment with robot-assisted laparoscopic retroperitoneal lymph node dissection with concomitant inferior vena cava thrombectomy and cava reconstruction on September 12, 2018. During the procedure, a drop-in robotic ultrasound probe was used to define the thrombus. Vena cavoscopy using a flexible ureteroscope found that the tumor thrombus adhered to the cava wall in all directions. The tumor thrombus was dissected free from the inferior vena cava lumen, and vena cava reconstruction was achieved using the da Vinci™ Si HD surgical system. The operative time was 550 minutes. The intraoperative estimated blood loss was 2300 ml. Intraoperative blood transfusions consisted of 10 units of red blood cells (Clavien-Dindo grade II). No Clavien-Dindo grade III or above perioperative complications occurred. The length of hospital stay was 7 days. Pathology revealed no viable cancer cells in any of the residual lymph node tissues or in the vena cava tumor thrombus. Conclusion This is the first case of robot-assisted laparoscopic retroperitoneal lymph node dissection with concomitant inferior vena cava thrombectomy and reconstruction for metastatic mixed testicular germ cell cancer published to date. This complicated surgical procedure was facilitated by the innovative usage of three-dimensional image reconstruction for defining the vena cava tumor thrombus, a robotic ultrasound probe for intraoperatively defining the vena cava tumor thrombus, and vena cavoscopy using a flexible ureteroscope.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…It is unlikely, however, that side effects would differ from what is generally known from recent primary laparoscopic RPLND series (postoperative complication rate 0-9.8%) [31]. In a large series by Nicolai et al [32] only 8/221 patients (3.6%) who underwent laparoscopic RPLND had a complication with Clavien-Dindo grade >2. Nevertheless, patients with a suspicion of TGCT but without evidence of TGCT on testicular pathology (two patients in our series) were unnecessarily subjected to an invasive procedure.…”

Section: Discussionmentioning

confidence: 90%

“…In a large series by Nicolai et al. only 8/221 patients (3.6%) who underwent laparoscopic RPLND had a complication with Clavien–Dindo grade >2. Nevertheless, patients with a suspicion of TGCT but without evidence of TGCT on testicular pathology (two patients in our series) were unnecessarily subjected to an invasive procedure.…”

Section: Discussionmentioning

confidence: 94%

Sentinel node biopsy in clinical stage I testicular cancer enables early detection of occult metastatic disease

et al. 2019

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ObjectivesTo report the long‐term results of the sentinel node (SN) approach in patients with clinical stage I testicular tumours in our facility.Patients and MethodsWe conducted an analysis of 27 consecutive patients suspected of clinical stage I testicular germ cell tumour (TGCT) and treated with an SN procedure at our tertiary referral centre. SNs were identified using lymphoscintigraphy with or without single‐photo‐emission computed tomography with CT (SPECT/CT). Patients underwent laparoscopic retroperitoneal SN excision with inguinal orchiectomy. Patients with a tumour‐positive SN underwent adjuvant treatment. Follow‐up was conducted according to then‐current guidelines.ResultsIn two patients, no SNs were visualized on scintigraphy. In the remaining 25 patients, a median (range) of 3 (1–4) SNs per patient were removed. Two patients showed no malignancy on histopathological examination of the testis. Of the 23 patients diagnosed with TGCT (16 seminomas, seven non‐seminomas), three (13.0%) had occult metastatic disease. All 23 patients were without evidence of disease at a median (range) follow‐up of 63.9 (29.0–143.4) months.ConclusionThe SN procedure allows early identification of patients with occult metastatic disease in clinical stage I TGCT, enabling early treatment.

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“…Several factors have been evaluated to estimate the risk of recurrence and described in the past [ [17] , [18] , [19] ]. The proportion of embryonal carcinoma, the proliferation rate and the lymphovascular invasion [ 20 ] have been described as prognostic factors of recurrence [ 17 , 19 , 21 ]. In multivariate analysis, lymphovascular invasion [ 20 ] overruled the other risk factors and is therefore used to stratify stage I NSGCT into “high risk” and “low risk” groups.…”

Section: Risk Factors For Stage I Nsgctsmentioning

confidence: 99%

“…The proportion of embryonal carcinoma, the proliferation rate and the lymphovascular invasion [ 20 ] have been described as prognostic factors of recurrence [ 17 , 19 , 21 ]. In multivariate analysis, lymphovascular invasion [ 20 ] overruled the other risk factors and is therefore used to stratify stage I NSGCT into “high risk” and “low risk” groups. Patients without lymphovascular invasion (LVI–) on histopathological report of orchiectomy represent the pathological stage pT1 and the clinical stage IA.…”

Section: Risk Factors For Stage I Nsgctsmentioning

confidence: 99%

Treatment of clinical stage I non-seminoma

Hiester

2021

Asian Journal of Urology

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Germ cell cancers are the most common solid tumors among men between 15 and 40 years. Non-seminomatous germ cell tumors (NSGCTs) represent a unique and exclusive cohort of germ cell tumor patients. Non-seminoma can harbor different histologic components. The most commonly found histologies are embryonal cell cancer, teratoma, yolk sack tumor and choriocarcinoma, as well as teratocarcinoma and seminoma, in combination with non-seminomatous germ cell tumors histologic types. The clinical definition of stage I non-seminoma is the absence of metastatic lesions on imaging and normal tumor markers. The cure rate for clinical stage I NSGCT is 99% and this can be achieved by three therapeutic strategies: Active surveillance with treatment at the time of relapse, retroperitoneal lymph node dissection or adjuvant chemotherapy. The balancing of these various strategies should always be based on an individual risk profile of NGSCG patient depending on the lymphovascular invasion of the tumor.

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Laparoscopic Retroperitoneal Lymph Node Dissection for Clinical Stage I Nonseminomatous Germ Cell Tumors of the Testis: Safety and Efficacy Analyses at a High Volume Center

Cited by 22 publications

References 26 publications

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

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

Sentinel node biopsy in clinical stage I testicular cancer enables early detection of occult metastatic disease

Treatment of clinical stage I non-seminoma

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