Laparoscopic retroperitoneal lymph node dissection combined with adjuvant chemotherapy for pathological stage II disease in nonseminomatous germ cell tumours: a 15‐year experience

Abstract

OBJECTIVE To present our 15‐year experience of laparoscopic retroperitoneal lymph node dissection (LRPLND) combined with adjuvant chemotherapy (after RPLND) for patients with nonseminomatous germ cell tumour and positive nodes (pN+), evaluating the morbidity and long‐term oncological outcome. PATIENTS AND METHODS Data for 87 patients with clinical stage I GCT were collected prospectively from 1992 to 2007. Primary diagnostic LRPLND was performed for pathological staging using a modified‐template dissection. Patients with lymph node involvement had adjuvant chemotherapy, with two cycles of bleomycin, etoposide and cisplatin. RESULTS The mean (range) operative duration was 177 (68–360) min, and the hospital stay 6 (4–18) days. Positive nodes were identified in 24% of patients, who subsequently had adjuvant chemotherapy. After a mean (range) follow‐up of 84 (1–186) months, distant relapse occurred in 9% of patients with pathological stage I (no adjuvant chemotherapy), including three patients with pulmonary metastases, two with retroperitoneal recurrence (outside the template field), two biochemical recurrences (α‐fetoprotein elevated) and one port‐site metastasis. No patients with pN+ disease relapsed. There were complications after surgery in 9% of patients, i.e. one pulmonary embolus, one lymphocoele, temporary ureteric stenting in two, ureteric stenosis requiring surgical repair in three and retrograde ejaculation in one patient. All patients remain disease‐free. CONCLUSIONS After gaining experience, LRPLND has comparable operative times to contemporary open series, and low morbidity. The two retroperitoneal recurrences (2.5%) were outside the template field. No patients with pN+ had a recurrence, showing the efficacy of adjuvant chemotherapy. Our approach provides excellent oncological outcomes, avoiding intensive surveillance.

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

“…However, when minimally invasive approaches are applied to surgical oncology, it is critical to ensure that cancer control is not compromised. Although several large published series have established the safety and feasibility of L‐RPLND, the therapeutic efficacy of L‐RPLND has been questioned because nearly all patients with histologically positive nodes received adjuvant chemotherapy [4–6]. We report that patients with pathological stage II NSGCT can be managed with close surveillance.…”

Minimally Invasive Retroperitoneal Lymphadenectomy

“…In recent series only 1.1% for RLA and not a single conversion for PL-RLA were described. 54,55 A frequent postoperative finding is chylous ascites. In most of these cases, conservative treatment with a low-fat or medium-chain triglyceride diet is effective.…”

A systematic review of the correlates and management of nonpremature ejaculatory dysfunction in heterosexual men

“…Nerve-sparing RPLND at least on one side in advanced testicular cancer following chemotherapy, was associated with 84.6% antegrade ejaculation [Nonomura et al 2002]. More recently, laparoscopic RPLND using a modified template dissection and adjuvant chemotherapy for NSGCT stage II was associated with minimal retrograde ejaculation rate affecting 3.4% of patients [Cresswell et al 2008].…”